CPT code 95060 is a specific code used to identify eye allergy tests performed by healthcare providers for accurate documentation and reporting.
CPT code 95060 is used to describe eye allergy tests, specifically conjunctival tests for hypersensitivity. This code is utilized when a healthcare provider performs a test to determine if a patient has an allergic reaction in the eyes, often involving the application of allergens to the conjunctiva to observe any allergic response. This procedure is typically conducted to diagnose conditions such as allergic conjunctivitis and to identify specific allergens that may be causing the patient's symptoms.
For CPT code 95060, which pertains to eye allergy tests, the following modifiers may be applicable:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service. This modifier is used when an evaluation and management service is provided on the same day as the eye allergy test, indicating that the service was distinct and necessary.
2. Modifier 59: Distinct Procedural Service. This modifier is used to indicate that the eye allergy test was performed as a separate and distinct service from other procedures or services provided on the same day. It helps in situations where procedures are not normally reported together but are appropriate under the circumstances.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the eye allergy test needs to be repeated on the same day by the same provider, indicating that the repeat procedure was necessary.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the eye allergy test is repeated on the same day by a different provider, signifying that the repeat procedure was necessary.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. Although less common for this specific procedure, this modifier may be used if the eye allergy test is repeated for clinical reasons to obtain additional information.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It is important to use them appropriately to avoid claim denials or delays.
CPT code 95060, which pertains to eye allergy tests, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. To determine if CPT code 95060 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining coverage and reimbursement for specific services within their jurisdictions. MACs may have local coverage determinations (LCDs) that affect whether CPT code 95060 is reimbursed. Providers should review any relevant LCDs and communicate with their regional MAC to ensure compliance with Medicare's billing and documentation requirements for this specific code.
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