CPT code 92002 is a billing code for a new patient eye examination.
CPT code 92002 is used to document a new patient eye examination that includes a history and general medical observation, external and ophthalmoscopic examination, and basic decision-making. This code is specifically for situations where the patient has not previously been seen by the physician or another physician of the same specialty in the same group practice within the past three years.
CPT code 92002, which represents an eye examination for a new patient that includes a history and medical examination with an initiation of diagnostic and treatment programs, may require modifiers depending on the specific circumstances of the service provided. Here are some commonly used modifiers for this CPT code:
1. -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used when a significant, separately identifiable E/M service is performed on the same day as the eye exam.
2. -24 Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: If the eye exam is performed during the postoperative period of another procedure but is unrelated to that procedure, this modifier would be appropriate.
3. -57 Decision for Surgery: Use this modifier if the decision to perform surgery is made during the eye exam, indicating that the exam led to the decision for surgery.
4. -LT and -RT Left Side and Right Side: These modifiers are used to specify which eye was examined if only one eye was involved in the examination.
5. -50 Bilateral Procedure: If the examination involves both eyes, this modifier should be used to indicate a bilateral procedure.
6. -95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System: If the eye exam is performed via telemedicine, this modifier would be applicable.
7. -22 Increased Procedural Services: This modifier is used when the service provided is substantially greater than typically required.
Each of these modifiers provides a way to specify the nature of the service provided more accurately, ensuring appropriate reimbursement and compliance with billing regulations.
CPT code 92002, which pertains to a new patient eye examination for the evaluation and management of a specific ocular problem, is generally reimbursed by Medicare. However, the reimbursement for this code can vary based on geographic location and the specifics of the Medicare plan. As of the most recent data, the national average Medicare reimbursement for CPT code 92002 is approximately $76. However, providers should verify the exact reimbursement rates in their specific locality and ensure that all documentation and billing practices meet Medicare's requirements to facilitate proper reimbursement.
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