CPT code 92517 is used for a VEMP test, which assesses the function of the cervical vestibular system in the inner ear.
CPT code 92517 is used to describe the Vestibular Evoked Myogenic Potential (VEMP) test, specifically for the interpretation and reporting of cervical VEMP results. This diagnostic procedure assesses the function of the vestibular system, which is part of the inner ear responsible for balance. The cervical VEMP test evaluates the saccule and the inferior vestibular nerve by measuring the reflexive muscle responses in the neck. It is commonly used to diagnose vestibular disorders and assess balance function in patients.
For CPT code 92517, which pertains to the VEMP test involving the cervical region, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the test results, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and technician services, excluding the professional interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if multiple procedures are performed and need to be reported separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary to be performed more than once.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day. It indicates that the procedure was necessary to be performed more than once by a different provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this specific code, this modifier is used when a laboratory test is repeated on the same day to obtain subsequent results. It may apply if the VEMP test is considered a diagnostic test and needs to be repeated for clinical reasons.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 92517, which refers to a specific procedure, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a crucial resource that determines whether a particular CPT code is reimbursable and at what rate. Healthcare providers should consult the MPFS to verify if CPT code 92517 is listed and the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and may have specific local coverage determinations (LCDs) that affect whether CPT code 92517 is reimbursed in certain regions. Providers should check with their respective MAC to ensure compliance with any regional policies or requirements that might impact reimbursement for this code.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. For instance, with RevFind, you can identify discrepancies related to CPT code 92517. Schedule a demo today to see how our solution can help you maximize your revenue and ensure you are being reimbursed correctly.
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
