Optometric Billing-Billing Medicare for 92250
- By Andrew Roy
- •
- 26 Jan, 2016
- •
...and how to properly bill 92250 to ALL insurance companies
QUESTION:
I submitted numerous claims for fundus photography with the bilateral procedure modifier to indicate that the procedure was performed on both eyes, but the services were rejected. Why?
ANSWER:
Now, for all the good little boys and girls out there you should remember that since this code is bilateral you should append it with 52-LT or 52-RT respectively if you only performed this service on one eye. That way, you will be properly paid the reduced rate and not be yelled at by an auditor should they ever come knocking at your door....but you wouldn't not do this, right ? :-p
I submitted numerous claims for fundus photography with the bilateral procedure modifier to indicate that the procedure was performed on both eyes, but the services were rejected. Why?
ANSWER:
In the Medicare Physician Fee Schedule Database (MPFSDB), fundus photography (CPT code 92250) is designated as a Bilateral Indicator 2 code, which means that payment is already based upon it being performed bilaterally. Therefore, CPT modifier 50 should not be submitted with CPT code 92250. When CPT code 92250 is performed bilaterally, simply submit it as CPT code 92250 (one unit) without CPT modifier 50.
(Link for original post found here)
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