CPT code 92352 is for fitting a monofocal spectacle lens for one eye, typically after cataract surgery.
CPT code 92352 is designated for the fitting of a monofocal lens in patients with aphakia when using spectacles. Aphakia refers to the absence of the lens of the eye, which can occur naturally or be due to surgical removal. This code covers the professional services involved in fitting a single-focus lens into a spectacle frame to correct vision in such patients.
For the CPT code 92352, which pertains to the fitting of a monofocal lens for aphakia (typically following cataract surgery), 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. -LT (Left side): Used to specify that the service (fitting of the spectacles) was performed on the left eye.
2. -RT (Right side): Used to specify that the service was performed on the right eye.
3. -50 (Bilateral procedure): If the fitting involves both eyes, this modifier should be used to indicate a bilateral procedure.
4. -EY (Eyeglasses involved): This modifier is specific to services related to eyeglasses, which is relevant in the case of fitting monofocal lenses for aphakia.
5. -TC (Technical component): This could be used if only the technical part of the service (like the actual fitting and adjustment of the spectacles) is provided, without any professional interpretation or supervision.
6. -26 (Professional component): Used when only the professional component of the service is provided, such as the supervision of the fitting and not the actual fitting itself.
7. -22 (Increased procedural services): This modifier may be used if the service provided is more complex or requires more effort than typically required for this code.
8. -52 (Reduced services): If the service provided is less than what is usually required for this CPT code, this modifier should be applied.
Each of these modifiers helps in accurately describing the service provided, ensuring appropriate reimbursement and compliance with billing regulations. It's important for healthcare providers to select the correct modifier(s) based on the specific details of the service performed.
The CPT code 92352, which pertains to the fitting of a monofocal lens for aphakia (typically following cataract surgery), is generally reimbursed by Medicare. However, the exact reimbursement amount can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, local coverage determinations, and specific billing circumstances related to the patient's condition and the provider's practice setting.
To determine the precise reimbursement amount for CPT code 92352, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or directly contact their regional MAC. This will provide the most accurate and region-specific reimbursement details, ensuring compliance with Medicare billing regulations and policies.
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