CPT code 92227 is used for billing remote imaging for detection, monitoring, and management of diseases by healthcare staff.
CPT code 92227 is used for billing remote imaging for detection or monitoring of retinal disease. This code specifically applies to instances where images are obtained through a remote device, and the data is then forwarded to a healthcare provider for analysis and interpretation. This service is typically utilized for patients who require monitoring for conditions such as diabetic retinopathy or macular degeneration, allowing for frequent assessments without the need for in-person visits every time.
CPT code 92227, which refers to remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes), is a procedure that may require specific modifiers depending on the billing circumstances and documentation requirements. Here’s a list of potential modifiers that could be applicable:
1. -TC (Technical Component): This modifier is used when only the technical component of the procedure is being billed. For instance, if the equipment is used to capture the retinal images but the interpretation is done by another provider.
2. -26 (Professional Component): Applied when only the professional component of the service is billed. This would be used if the provider is interpreting the remotely captured images but did not handle the technical aspect of capturing the images.
3. -95 (Telemedicine): Since CPT 92227 involves remote imaging, this modifier might be used to specify that the service was delivered via telehealth technologies.
4. -LT (Left side) and -RT (Right side): These modifiers are used to indicate services performed on the left or right side of the body, respectively. In the context of retinal imaging, these could be relevant if images are taken of only one eye.
5. -76 (Repeat Procedure by Same Physician): This modifier could be used if the same physician needs to repeat the imaging procedure on the same day, possibly due to issues with initial image quality.
6. -77 (Repeat Procedure by Another Physician): Similar to -76, but used if the repeat imaging is performed by a different physician on the same day.
7. -59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This might be applicable if multiple different tests or procedures are done on the same day as the retinal imaging.
Each of these modifiers serves to provide additional details that can affect reimbursement and are essential for accurate billing and compliance with payer policies.
CPT code 92227, which refers to remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes), is reimbursable by Medicare under certain conditions. This code is typically used for services where images are evaluated by a qualified physician or other qualified healthcare professional.
Medicare reimbursement for CPT code 92227 is contingent upon the service being deemed medically necessary and the patient meeting specific criteria related to the risk and presence of retinal disease. The reimbursement amount for this code can vary based on geographic location and the setting in which the service is provided (e.g., in a physician's office versus a facility setting).
To determine the exact reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through Medicare Administrative Contractors (MACs) that manage claims and payments in specific regions.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision down to the CPT code level, including specific codes like 92227 for imaging retina detection/monitoring by staff. Schedule a demo today to see how RevFind can ensure you're fully compensated for every service rendered by each individual payer. Don't miss out on revenue you're entitled to—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
