CPT code 92393 is a billing code for the supply of an artificial eye.
CPT code 92393 is designated for the supply of an artificial eye. This includes the provision and fitting of the prosthetic eye, but does not cover any associated surgical procedures.
For the CPT code 92393, which is associated with the supply of an artificial eye, certain modifiers may be applicable depending on the specific billing circumstances and payer requirements. Here is an ordered list of potential modifiers that could be used with this code and the reasons for each:
1. LT (Left Side) - Used to specify that the service or item, such as an artificial eye, is provided on the left side of the body. This is crucial for clarity in claims processing to ensure accurate medical records and appropriate payment.
2. RT (Right Side) - Similar to the LT modifier, this is used to indicate that the artificial eye is for the right side of the body. Using LT or RT helps in specifying the exact side treated or fitted, which is essential for bilateral organs or structures.
3. EY (Eyeglasses) - Although primarily used for eyeglasses, this modifier might be relevant if the artificial eye is part of a broader prosthetic setup that includes eyeglass-like structures for mounting or support. This would be less common but applicable in specific custom prosthetic devices.
4. NU (New Equipment) - This modifier indicates that the artificial eye supplied is brand new. It's important for billing purposes as some insurance policies might have different coverage stipulations for new vs. used or refurbished equipment.
5. RA (Replacement of a DME Item) - If the artificial eye is a replacement for a previously issued prosthetic, this modifier would be necessary to indicate that the item is a replacement, which can affect coverage and payment.
6. GA (Waiver of Liability Statement Issued) - This is used when a provider expects that the service or item provided may be denied as not reasonable and necessary under Medicare but has obtained a signed waiver from the patient acknowledging that they will be responsible for payment if denied.
7. GY (Item or Service Statutorily Excluded) - If the artificial eye is not covered by the patient's insurance plan, this modifier would be used to indicate that the item or service is expected to be denied as it is not a covered benefit.
8. GZ (Item or Service Expected to be Denied as Not Reasonable and Necessary) - Similar to GA, but used when no waiver of liability form has been signed by the patient. This informs the payer that the provider expects the claim to be denied due to the service being deemed not reasonable and necessary.
Each of these modifiers provides specific information that helps in the accurate processing of claims related to the supply of an artificial eye, ensuring compliance with billing regulations and facilitating appropriate reimbursement from payers.
Medicare does provide reimbursement for the supply of an artificial eye, which is represented by the CPT code 92393. However, the specific amount of reimbursement can vary based on the Medicare Administrative Contractor (MAC) that processes the claim, as well as factors such as the geographic location where the service is provided and any applicable Medicare policies at the time of the claim.
To determine the exact reimbursement amount, it is advisable for healthcare providers to check with their local MAC or utilize the Medicare Physician Fee Schedule Lookup Tool available on the CMS (Centers for Medicare & Medicaid Services) website. This tool allows providers to input specific codes and other details to receive accurate and up-to-date reimbursement information. Additionally, providers should ensure that all claims for the supply of an artificial eye meet the necessary documentation and eligibility requirements set forth by Medicare to facilitate proper reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. RevFind is adept at reading your contracts and identifying discrepancies down to the CPT code level, including specific codes like 92393 for the supply of an artificial eye. By analyzing payments from individual payers, RevFind ensures that every claim is compensated correctly according to your contractual agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to.
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