CPT code 92100 is for serial tonometry exams, which measure intraocular pressure over time.
CPT code 92100 is designated for serial tonometry exams. This procedure involves multiple intraocular pressure measurements over an extended period, typically to monitor and assess the stability or progression of conditions like glaucoma. The serial aspect of the test allows for a more comprehensive understanding of the intraocular pressure fluctuations that might occur throughout the day, which can be crucial for effective disease management and treatment planning.
For CPT code 92100, which is designated for serial tonometry examinations, 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. -26 (Professional Component): This modifier is used when only the professional component of the service is being billed because the equipment or facilities were provided by another entity. It indicates that the physician is charging only for their professional expertise.
2. -TC (Technical Component): Conversely, this modifier is used when only the technical component of the service is being billed. This might be applicable if the physician owns the equipment but did not personally perform or interpret the examination.
3. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify which eye was examined if only one eye was tested. This is crucial for accurate billing and medical records.
4. -50 (Bilateral Procedure): If the tonometry examination is performed on both eyes during the same session, this modifier should be used to indicate a bilateral procedure.
5. -76 (Repeat Procedure by Same Physician): This modifier is used if the tonometry exam needs to be repeated in the same session by the same physician, perhaps due to initial measurement errors or equipment malfunction.
6. -59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or separate from other services performed on the same day. It is often used to signify that the procedure was not typically performed or expected to be performed on the same day.
7. -22 (Increased Procedural Services): If the tonometry examination requires significantly more effort or time than typically required, this modifier can be used to indicate an increased level of service.
Each of these modifiers serves to provide specific details about the service provided, ensuring accurate billing and compliance with payer requirements. It's important for healthcare providers to use these modifiers correctly to avoid billing errors and potential denials.
CPT code 92100, which refers to serial tonometry exams, is generally reimbursable by Medicare. However, the specific amount of reimbursement can vary based on the Medicare Administrative Contractor (MAC) in the specific geographic region where the services are provided. It's important for healthcare providers to check with their local MAC for the most accurate and current reimbursement rates for this procedure. Additionally, providers should ensure that the documentation supports the medical necessity of the procedure in each case to facilitate appropriate reimbursement.
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