CPT code 92015 is used for billing the determination of a patient's refractive state in eye care.
CPT code 92015 is used to denote a procedure where an eye care professional determines the refractive state of the eye. This involves measuring the eye's ability to focus light correctly, which is essential for identifying the correct prescription for glasses or contact lenses. The test assesses whether the patient has conditions like nearsightedness, farsightedness, or astigmatism.
CPT code 92015, which pertains to the determination of refractive state, may require the use of modifiers depending on the specific circumstances of the billing and service provided. Here is an ordered list of common modifiers that might be applicable to this code 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 if the provider performs a significant, separate evaluation and management service on the same day as the refractive state determination.
2. -LT Left Side: Used when the service (determination of refractive state) is performed only on the left eye.
3. -RT Right Side: Used when the service is performed only on the right eye.
4. -50 Bilateral Procedure: Applied when the procedure is performed on both eyes during the same session.
5. -TC Technical Component: This modifier is used when only the technical portion of the procedure is being billed (i.e., the use of equipment and technician time), and the professional component (interpretation and report) is not included.
6. -26 Professional Component: Indicates that only the professional component of the procedure is being billed. This is used when the provider is only interpreting and reporting on a test performed elsewhere.
7. -59 Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day.
8. -76 Repeat Procedure by Same Physician: This modifier is used if the test needs to be repeated on the same day by the same physician.
9. -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is applicable if the determination of refractive state is performed during the postoperative period of a different, unrelated procedure.
Each of these modifiers serves to provide specific details that can affect billing and reimbursement processes, ensuring that the services rendered are accurately documented and charged.
CPT code 92015, which pertains to the determination of the refractive state of the eyes, is generally reimbursable by Medicare. This procedure involves an assessment to prescribe glasses or other corrective lenses.
Medicare typically covers this code under the outpatient setting when it is deemed medically necessary, such as part of a comprehensive eye examination or when specific visual symptoms are present that require evaluation. However, routine eye exams for prescribing glasses may not be covered unless linked to a chronic condition that Medicare recognizes as requiring regular eye assessments.
The reimbursement amount for CPT code 92015 can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, the locality-specific fee schedule, and whether the service is performed in a facility or non-facility setting. Providers should consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the CMS (Centers for Medicare & Medicaid Services) website to determine the exact reimbursement rate for their locality.
It is also important for providers to verify coverage and documentation requirements with Medicare to ensure compliance and proper claim submission, as these factors can influence reimbursement.
Discover how MD Clarity's RevFind software enhances your revenue cycle management by accurately reading your contracts and identifying underpayments with precision down to the CPT code level, including specific codes like 92015 for determining refractive state. Schedule a demo today to see how RevFind can streamline your process and ensure you are fully compensated by each payer. Don't miss out on revenue you are rightfully owed. Let RevFind safeguard your financial health.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
