Coding Information
Use CPT code(s) 92133 or 92134 to report OCT, include any necessary modifiers (e.g. 26, TC).
How often can you bill CPT 92134?
92134 is allowed more often – typically up to 4 times per year – or once per month in patients with retinal conditions undergoing active intravitreal drug treatment.
When can 92134 and 92250 be billed together?
The medical record should clearly document the medical necessity of each service. Frequent reporting of these services together may trigger focused medical review. Answer: Novitas will allow the unbundling of CPT codes 92134 and 92250 with the -59 modifier when medically necessary.
Can 92133 and 92134 be billed together?
Based on CPT Code descriptions, CPT Code 92133 and/or 92134 cannot be reported at the same patient encounter. CPT codes 92133 and/or 92134 will be considered in this edit, if billed together during the same patient encounter, on the same date of service.
Can 92132 and 92134 be billed together?
92132: Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. ► Do not report 92133 and 92134 at the same patient encounter.
Is CPT 92134 covered by Medicare?
A: CPT instructs that 92133 and 92134 may not be reported at the same patient encounter. Medicare’s National Correct Coding Initiative (NCCI) treats fundus photography (92250) as mutually exclusive with SCODI-P. The E/M service 99211 is bundled with this test.
Is 92134 a bilateral code?
CPT code 92134 indicates “unilateral or bilateral,” meaning that the provider is paid the same amount whether one or both eyes are tested. By contrast, CPT code 76512 reads: Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed nonquantitative A-scan).
Can you bill for a visual field and OCT on the same day?
Although the visual field codes are not bundled with OCT (92133-92134), some MACs may question the medical necessity for both tests on the same day; if they are both done, the chart documentation must justify the medical necessity for each test.
What is the CPT code for optical coherence tomography?
As optical coherence tomography angiography (OCTA) grows in prevalence in the retina community, coding questions arise. OCTA should be reported with CPT 92134 alone. No other CPT code suffices, and no additional CPT code is needed.
Is corneal topography covered by Medicare?
Corneal topography is not bundled by Medicare with either eye exams or other tests. Additionally, according to CPT instructions, corneal topography is not to be reported in conjunction with corneal transplant (65710-54755).
What is the CPT code for OCT?
This coding path had a major flaw. The American Medical Association publication of the CPT clearly defines the coding of OCT-A to be exactly the same as coding for OCT: 92134. This code alone is the proper way to code the procedure—no enhancements or embellishments, and no increased reimbursement.
Does 92250 need a modifier?
CPT codes 92250 and 92228 describe services that are performed bilaterally. Modifier 50 is never appropriate with these codes.
Does Medicare pay for 92250?
A Yes. According to Medicare’s National Correct Coding Initiative (NCCI), 92250 is bundled with ICG (92240) and mutually exclusive with scanning computerized ophthalmic diagnostic imaging of the posterior segment (92133 or 92134).
How do you bill fundus photography?
Q. What CPT code is used to report fundus photography? A. Use CPT code 92250 (Fundus photography with interpretation and report) to report this test.
Does Medicare pay for OCT scan?
Q: Does Medicare cover SCODI of the posterior segment with Topcon’s 3D OCT-1 Maestro2? A: Yes. Scanning computerized ophthalmic diagnostic imaging of the posterior segment (SCODI-P) is covered by Medicare subject to the limitations in its payment policies; other third party payers generally agree.
What is the CPT code for refraction?
Refraction: CPT 92015 describes refraction and any necessary prescription of lenses. Refraction is not separately reimbursed as part of a routine eye exam or as part of a medical examination and evaluation with treatment/diagnostic program.
How often can you bill for Gonioscopy?
The AAO’s Preferred Practice Patterns suggests that gonioscopy be repeated periodically and mentions every 1 to 5 years. Repeat testing is indicated when medically necessary for new symptoms, progressive disease, new findings, unreliable prior results, or a change in the treatment plan.
