CPT code 92065 is used for billing orthoptic training performed by a physician or qualified healthcare professional.
CPT code 92065 is designated for orthoptic and/or pleoptic training, performed by a physician or other qualified healthcare professional. This code is used when these specific visual therapy services are provided to treat conditions such as strabismus or other binocular vision anomalies. The training typically involves exercises and techniques aimed at improving visual coordination and alignment.
For CPT code 92065 (Orthoptic and/or pleoptic training, with continuing medical direction and evaluation), the application of modifiers can be essential to accurately represent the circumstances of the service provided. Here is an ordered list of relevant modifiers and the reasons for their use:
1. Modifier 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, on the same day as the orthoptic training, a separate and distinct E/M service is performed that is above and beyond the usual preoperative and postoperative care associated with the training.
2. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the training is distinct or independent from other services performed on the same day. It helps in situations where other procedures that might normally be bundled into this service are performed separately.
3. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the orthoptic training is repeated on the same day, indicating a separate session.
4. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable if another physician repeats the orthoptic training on the same day.
5. Modifier 95 - Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System: If the orthoptic training is performed via telemedicine, this modifier should be used to specify that the service was delivered through real-time interactive audio and video.
6. Modifier GT (or use Modifier 95 as per CMS guidelines) - Via Interactive Audio and Video Telecommunications Systems: Similar to Modifier 95, this is used for services rendered via telehealth, primarily in cases where specific payer requirements dictate its use over Modifier 95.
7. Modifier 22 - Increased Procedural Services: This modifier can be used if the service provided is substantially greater than typically required, which should be documented and justified in the medical records.
Each modifier has specific implications for billing and reimbursement, and their appropriate use can significantly impact the accuracy of claims and the efficiency of revenue cycle management in healthcare settings. Always ensure compliance with payer-specific guidelines when applying these modifiers.
CPT code 92065, which pertains to orthoptic and/or pleoptic training performed by a physician or other qualified healthcare professional, is generally reimbursable by Medicare. However, the specific coverage and reimbursement rates can vary based on the Medicare Administrative Contractor (MAC) that services a particular geographical area.
To determine the exact reimbursement amount for CPT code 92065, healthcare providers should consult the fee schedule provided by their local MAC. This information is typically accessible through the MAC's official website or by contacting their customer service. It's important to note that documentation and medical necessity play crucial roles in ensuring that services billed under this code are reimbursed. Providers should ensure that all required documentation is accurately and thoroughly completed to facilitate the reimbursement process.
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