CPT code 92060 is a billing code for a specialized eye evaluation involving sensorimotor examination.
CPT code 92060 is a medical billing code used to describe a specialized eye evaluation. This code specifically refers to a sensory-motor examination with multiple measurements of ocular deviation performed with an observation and recording of a patient’s ability to follow objects visually. It is typically used when assessing for strabismus or other similar eye movement disorders. This evaluation is more comprehensive than a routine eye exam, focusing on the functional aspects of eye movement and coordination.
For CPT code 92060, which is designated for a special eye evaluation involving sensorimotor examination, several modifiers may be applicable depending on the specific circumstances of the healthcare service provided. Here’s an ordered list of potential modifiers and the reasons for their use:
1. -22 (Increased Procedural Services): This modifier is used when the service provided is significantly greater than typically required. It can be applied if the eye evaluation requires extra effort or time due to severe patient conditions.
2. -24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): If the eye evaluation is performed during the postoperative period of a different procedure and is not related to the original procedure, this modifier should be used.
3. -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): If, on the day of the eye evaluation, an additional, distinct service is provided, this modifier would be appropriate.
4. -52 (Reduced Services): Use this modifier when the service provided is less than what is usually required for the 92060 CPT code. This might be applicable if only a partial sensorimotor exam is performed.
5. -53 (Discontinued Procedure): This modifier is applicable if the eye evaluation is terminated after initiation due to extenuating circumstances or those that threaten the well-being of the patient.
6. -57 (Decision for Surgery): If the special eye evaluation leads to the decision to perform surgery, this modifier should be used, especially if the decision is made during an evaluation and management service that resulted in the initial decision to perform surgery.
7. -59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is not typically bundled with other services, but is distinct and independent on the day it is performed.
8. -76 (Repeat Procedure by Same Physician): If the special eye evaluation needs to be repeated by the same physician, use this modifier to indicate a repeated procedure.
9. -77 (Repeat Procedure by Another Physician): Similar to -76, but used when the procedure is repeated by a different physician.
10. -91 (Repeat Clinical Diagnostic Laboratory Test): In the rare case that a part of the eye evaluation involves repeating a diagnostic test on the same day, this modifier could be used.
Each modifier has specific documentation requirements and should be used accurately to ensure proper billing and reimbursement. It’s essential to consult current coding guidelines and payer policies as these can frequently change.
CPT code 92060, which pertains to a special eye evaluation involving sensorimotor examination with multiple measurements of ocular deviation, is generally reimbursable by Medicare. However, the specific reimbursement amount for this code can vary based on the geographic location and the setting in which the service is provided (e.g., outpatient hospital, physician's office). It is important for healthcare providers to check the Medicare Physician Fee Schedule (MPFS) for the exact reimbursement rate applicable in their region.
Additionally, providers should ensure that the documentation supports the medical necessity of the procedure as outlined in Medicare guidelines to facilitate appropriate reimbursement.
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