CPT code 92014 is for an established patient's eye examination and treatment, typically requiring at least one follow-up visit.
CPT code 92014 is used for billing purposes to denote an eye examination and treatment for an established patient, which includes a comprehensive evaluation and may involve multiple visits. This code is specifically for patients who have previously been seen by the healthcare provider, indicating ongoing care and management of the patient's eye health.
For CPT code 92014, which is used for a comprehensive eye examination for an established patient that may include a history, general medical observation, external and ophthalmoscopic examination, gross visual fields, and basic sensorimotor examination, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of potential modifiers and the reasons for their use:
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, on the same day as the eye exam, a significant and separate E/M service is performed that is not related to the decision to perform 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 the original 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 examination visit, 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 visit.
5. -50 - Bilateral Procedure: If the eye exam involves both eyes and the payer requires specific notation for bilateral procedures, this modifier would be used.
6. -22 - Increased Procedural Services: This modifier is used when the work required to perform the eye exam is substantially greater than typically required, which should be documented thoroughly.
7. -52 - Reduced Services: If the eye exam is partially reduced or eliminated at the physician's discretion, this modifier indicates that a service was less extensive than usual.
8. -AI - Principal Physician of Record: This modifier is used to identify the physician who oversees the patient's comprehensive care and is distinct from other specialists who might be involved in a portion of the patient care.
Each of these modifiers serves to provide additional information to payers about the circumstances under which the eye exam was performed, ensuring appropriate reimbursement and clarity in patient medical records. It's important to check with specific payer policies as the applicability and requirements for these modifiers can vary.
CPT code 92014, which pertains to an eye examination and treatment for established patients, encompassing at least one visit, is generally reimbursed by Medicare. The reimbursement for this code can vary based on geographic location due to differences in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement amount, it is advisable to consult the MPFS lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website, where you can input specific details such as the locality to get precise data. This will provide the most accurate and up-to-date reimbursement rates for CPT code 92014 in your specific region.
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