CPT CODES

CPT Code 65155

CPT code 65155 is a medical code for the procedure of reinserting an ocular implant.

Table of Contents
What is CPT Code 65155
Does CPT 65155 Need a Modifier?
CPT Code 65155 Medicare Reimbursement
Are You Being Underpaid for 65155 CPT Code?
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What is CPT Code 65155

CPT code 65155 is designated for the surgical procedure involving the reinsertion of an ocular implant. This code is used when a previously placed eye implant needs to be reinserted, which may occur due to various reasons such as displacement or complications from the initial surgery.

Does CPT 65155 Need a Modifier?

For CPT code 65155, which pertains to the reinsertion of an ocular implant, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of potential modifiers and the reasons for their use:

1. -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used if the reinsertion occurs as an unplanned event that necessitates a return to the operating room after the initial surgery.

2. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): If the reinsertion of the ocular implant is not related to the original procedure and occurs during the postoperative period, this modifier should be used.

3. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is applicable if the reinsertion was planned or staged as part of a series of treatments or if it is related to the initial procedure.

4. -76 (Repeat Procedure by Same Physician): Use this modifier if the same physician performs a repeat of the reinsertion procedure.

5. -77 (Repeat Procedure by Another Physician): This modifier is used if a different physician performs the reinsertion procedure.

6. -55 (Postoperative Management Only): In cases where only the postoperative management of the reinsertion is handled by the physician, this modifier should be applied.

7. -54 (Surgical Care Only): If the physician is only responsible for the surgical aspect of the reinsertion and not the preoperative or postoperative care, this modifier is appropriate.

8. -24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): If an unrelated evaluation and management service is provided during the postoperative period of the reinsertion, this modifier should be used.

Each of these modifiers addresses specific scenarios that might occur during the process of reinserting an ocular implant, ensuring accurate billing and documentation for the services provided.

CPT Code 65155 Medicare Reimbursement

Medicare reimbursement for CPT code 65155, which pertains to the reinsertion of an ocular implant, can vary based on several factors including the specific Medicare plan, the healthcare setting in which the procedure is performed, and regional Medicare Administrative Contractor (MAC) policies. Generally, this procedure is covered under Medicare Part B, which covers outpatient medical services, provided the procedure is deemed medically necessary and is performed by a qualified healthcare provider.

To determine the exact reimbursement amount for CPT code 65155, it is essential to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through your regional MAC. The reimbursement amount can differ by geographic location due to adjustments in the Relative Value Units (RVUs) and the application of locality-specific conversion factors.

Healthcare providers should also be aware that documentation and proper coding are crucial to ensure that the claim is processed smoothly and to avoid denials based on insufficient medical necessity or incorrect coding. It is advisable to check with the local MAC for any specific documentation requirements or additional guidelines pertaining to this procedure.

Are You Being Underpaid for 65155 CPT Code?

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