CPT Code 92396

CPT code 92396 is a billing code used by healthcare providers for the supply of contact lenses.

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What is CPT Code 92396

CPT code 92396 is designated for the supply of contact lenses. This code is used when a healthcare provider supplies a patient with contact lenses, typically following a prescription specified by an eye care specialist. The use of this code in billing ensures that the provision of the contact lenses is accurately documented and reimbursed.

Does CPT 92396 Need a Modifier?

For the CPT code 92396, which pertains to the supply of contact lenses, there are several modifiers that might be applicable depending on the specific billing circumstances and payer requirements. Here is an ordered list of common modifiers that could be used with this code:

1. -LT (Left Side): Used to specify that the service or item provided, in this case, contact lenses, is for the left eye.

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

3. -EY (Eyes): This modifier is used when the service pertains to both eyes. It's important to check payer policies as some might require the use of -LT and -RT instead of -EY.

4. -TC (Technical Component): This modifier could be used if only the technical component (provision of the contact lenses without additional professional services) is billed.

5. -26 (Professional Component): If billing specifically for the professional service involved in prescribing or fitting the lenses, separate from the supply of the lenses, this modifier would be applicable.

6. -99 (Multiple Modifiers): Used when two or more modifiers are necessary to completely describe a service.

Each modifier serves to provide additional clarity to the payer about the specific circumstances 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 92396 Medicare Reimbursement

Medicare generally does not cover routine vision services, such as eyeglasses and contact lenses. Therefore, the supply of contact lenses, typically billed under various HCPCS codes rather than CPT codes, is not reimbursed by Medicare under standard coverage. However, there are exceptions where Medicare may cover contact lenses or eyeglasses if they are required after cataract surgery that implants an intraocular lens. In such cases, Medicare Part B may cover a standard pair of prescription glasses or contact lenses, but only if the supplier is enrolled in Medicare.

For routine contact lens supplies, patients usually need to seek coverage through other insurance plans or pay out-of-pocket. It's important for healthcare providers to verify coverage specifics with Medicare or consult secondary insurance providers to determine if there is any coverage for contact lenses under different circumstances.

Are You Being Underpaid for 92396 CPT Code?

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