CPT code 92353 is for fitting a multifocal lens spectacle for patients with aphakia.
CPT code 92353 is designated for the fitting of contact lenses for the correction of aphakia, which is the absence of the lens of the eye. This specific code applies when the contact lenses are multifocal. The service includes both the initial fitting and the subsequent follow-up care to ensure proper fit and function of the contact lenses.
For the CPT code 92353, which pertains to the fitting of aphakic spectacles with multifocal lenses, 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 when the service or procedure is performed only on the left side of the body. This modifier would be applicable if the fitting is only for the left eye.
2. -RT (Right side): Used when the service or procedure is performed only on the right side of the body. This modifier would be applicable if the fitting is only for the right eye.
3. -50 (Bilateral procedure): Used when a procedure that is typically performed on one side of the body is performed on both sides during the same session. This would be applicable if the fitting involves both eyes.
4. -TC (Technical component): This modifier is used when only the technical portion of a service is billed because the equipment used is owned by the provider. For example, if the provider owns the equipment used to measure and fit the spectacles but does not engage in the professional service of analyzing the patient's vision or consulting.
5. -26 (Professional component): Indicates that only the professional component of the service is being billed. This is used when the provider is only charging for the professional service such as the consultation and fitting advice, but not for the use of any equipment.
6. -22 (Increased procedural services): This modifier is used when the service provided is greater than that usually required for the listed procedure. This could be applicable if extra time, effort, or equipment was needed to fit the spectacles due to unusual patient requirements.
7. -52 (Reduced services): Indicates that the service provided was less than usually required. This might be used if, for some reason, a full service fitting was not required or completed.
8. -59 (Distinct procedural service): Used to indicate that a service or procedure was distinct or independent from other services performed on the same day. This modifier might be necessary if multiple procedures were performed on the same day but were unrelated to the fitting of the spectacles.
Each of these modifiers provides a way to specify the exact nature of the services provided, ensuring accurate billing and reimbursement. It's important for healthcare providers to use these modifiers correctly to avoid billing errors and to ensure compliance with payer requirements.
The CPT code 92353, which pertains to the fitting of aphakic spectacles with multifocal lenses, is generally reimbursable by Medicare. However, the exact reimbursement amount can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, local coverage determinations (LCDs), and any applicable Medicare fee schedules.
To determine the specific reimbursement amount for CPT code 92353, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) available on the CMS (Centers for Medicare & Medicaid Services) website or contact their local MAC. This will provide the most accurate and up-to-date information regarding reimbursement rates for this particular service in their geographic area.
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