CPT Code 92395

CPT code 92395 is a billing code used for the supply of spectacles in healthcare settings.

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What is CPT Code 92395

CPT code 92395 is designated for the supply of spectacles, typically following cataract surgery. This code is used by healthcare providers to bill for the provision of eyeglasses, which are necessary for patients to achieve optimal vision after the procedure. The use of this code ensures that the services related to the dispensing of these spectacles are accurately documented and reimbursed.

Does CPT 92395 Need a Modifier?

For the CPT code 92395, which is associated with the supply of spectacles, certain modifiers may be applicable depending on the specific billing circumstances and payer requirements. Here is an ordered list of common modifiers that might be used with this code and the reasons for each:

1. LT (Left Side) - Used to specify that the service or item provided, such as spectacles, is for the left eye.

2. RT (Right Side) - Used to specify that the service or item provided is for the right eye.

3. -50 (Bilateral Procedure) - If spectacles are provided for both eyes during the same session, this modifier can be used to indicate a bilateral service.

4. -TC (Technical Component) - This modifier could be used if only the technical component of the spectacle supply is being billed (e.g., the physical glasses without professional services like fitting).

5. -26 (Professional Component) - Used when only the professional component of the service (such as the fitting or adjustment of the spectacles by a healthcare professional) is being billed, separate from the technical component.

6. -99 (Multiple Modifiers) - Used when multiple modifiers are necessary to fully explain one service.

Each of these modifiers serves to provide additional clarity to the payer about the specific nature of the service provided, ensuring appropriate reimbursement and minimizing billing errors and denials. Always verify with specific payer guidelines as modifier requirements can vary.

CPT Code 92395 Medicare Reimbursement

CPT code 92395, which pertains to the supply of spectacles, is generally not reimbursed by Medicare. Medicare typically does not cover routine vision services, including eyeglasses or contact lenses, except under specific circumstances, such as post-cataract surgery with intraocular lens placement. In such cases, Medicare may cover a standard pair of eyeglasses or contact lenses, but otherwise, eyewear is not covered.

For providers, it's important to note that patients will likely need to cover the cost of spectacles out-of-pocket unless they have additional vision insurance that provides for such expenses. Always ensure to check the patient's specific plan details and consider advising them on potential out-of-pocket costs for non-covered services like standard eyewear.

Are You Being Underpaid for 92395 CPT Code?

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