CPT code 92274 is a medical billing code for multifocal electroretinography with interpretation and report.
CPT code 92274 is used to denote a procedure known as multifocal electroretinography (ERG) with interpretation and report. This diagnostic test measures the electrical response of various cell types within the retina to light stimuli, helping to assess retinal function in multiple locations. The inclusion of interpretation and report indicates that the healthcare provider analyzes the results and provides a detailed summary of the findings. This test is particularly useful in diagnosing and monitoring diseases that affect retinal function.
For CPT code 92274, which pertains to multifocal electroretinography (ERG) with interpretation and report, certain modifiers may be applicable depending on the specific circumstances of the billing and the requirements of the payer. Here is an ordered list of common modifiers that might be used with this CPT code and the reasons for each:
1. -26 Professional Component: This modifier is used when only the professional component (interpretation and report) of the ERG is being billed because the technical component is being performed by another entity. This is common in situations where the testing equipment is owned by the hospital or another facility.
2. -TC Technical Component: Conversely, this modifier is used when only the technical component of the ERG is being billed. This might be applicable if the healthcare provider is responsible for the administration of the ERG but another provider is interpreting the results.
3. -LT Left Side and -RT Right Side: These modifiers are used to specify services performed on the left side and right side of the body, respectively. They might be used if the ERG is performed unilaterally and needs to be specified.
4. -50 Bilateral Procedure: If the ERG is performed on both eyes during the same session, this modifier would be appropriate to indicate a bilateral procedure.
5. -59 Distinct Procedural Service: This modifier is used to indicate that a service or procedure was distinct or independent from other services performed on the same day. This might be necessary if multiple tests or procedures are performed during the same visit.
6. -76 Repeat Procedure by Same Physician: This modifier could be used if the ERG needs to be repeated in the same session by the same physician due to specific clinical reasons.
7. -77 Repeat Procedure by Another Physician: Similar to -76, but used if the repeat ERG is performed by a different physician.
8. -22 Increased Procedural Services: This modifier may be used if the service provided is more complex than usually required for this CPT code. Documentation will be necessary to support the use of this modifier.
Each of these modifiers serves to provide additional information to the payer to ensure proper reimbursement and to clarify the specific circumstances of the service provided. It's important to check with individual payers as modifier requirements can vary.
CPT code 92274, which refers to Electroretinography (ERG) with multifocal testing, is generally reimbursable by Medicare under specific conditions. Medicare coverage for ERG, including multifocal, typically depends on the medical necessity as outlined in the local coverage determinations (LCDs) provided by the Medicare Administrative Contractors (MACs) that manage Medicare claims in specific regions.
To determine if 92274 is reimbursed in your specific case, you would need to consult the relevant LCDs for your region as these documents detail the indications and limitations of coverage based on clinical evidence and policy. These determinations also guide the amount reimbursed for the procedure.
The reimbursement amount for CPT code 92274 can vary by geographic location and the setting in which the service is provided (e.g., outpatient hospital, physician’s office). For accurate and current reimbursement rates, it is advisable to check the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or contact your local MAC.
It's important to ensure that all documentation supports the medical necessity of performing a multifocal ERG to facilitate appropriate reimbursement. Additionally, staying updated with any changes in Medicare policies or fee schedules that might affect the reimbursement for CPT code 92274 is crucial for healthcare providers.
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