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How to bill 92250 to Medicare

Marina Posted Tue 11th of June, 2013 21:31:27 PM

When billing code 92250 to Medicare, do I bill 2 seperate lines for each eye with modifiers or do I bill as 2 units on one line?

SuperCoder Answered Thu 13th of June, 2013 05:20:54 AM

This is a bilateral procedure and cannot be submitted with modifiers 50, RT, or LT. If only one eye is photographed it is recommended to add modifier 52 and modifier for which eye was photographed.

Medicare considers code 92250 to be inherently bilateral.Medicare already bases the relative value units (RVUs) for fundus photography on the procedure being performed bilaterally. Therefore, you should not append modifier 50 (Bilateral procedure). If you do, the carrier will most likely ignore it and just pay for one instance of 92250.

You can get a head start on preventing these snafus by looking in column Z ("Bilat Surg") in the physician fee schedule database to see if Medicare denotes that a procedure is bilateral. For 92250, there is a "2" in column Z, which means the payment adjustment for a bilateral procedure does not apply. A "0" or a "3" in that column would also indicate no bilateral payment, but a "1" would tell you that the procedure is considered unilaterally performed and should be reported with modifier 50 when performed bilaterally.

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