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IEHP California Medicaid - 92250

Karen Posted Mon 02nd of December, 2019 15:38:50 PM
This is for Insurance company IEHP California Medicaid Does a 92250 need a modifier ? Does it need units ?
SuperCoder Answered Tue 03rd of December, 2019 06:20:45 AM

Hello Karen,

 

Thanks for your Question.

 

As per the CMS, CPT code 92250 describe services that are performed bilaterally. Modifier 50 is never appropriate with these codes. Modifiers LT and RT should only be used if a unilateral service is performed.> 

Also, the MUE of this code is 1, which indicates that no more than 1 unit of service should be reported on the date of encounter.

Please find undermentioned link for your kind referencel

 

 

https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/32787_1/00625_OPHTH855_CBG_060112.pdf

 

 

 

 

Hope that helps!

 

Thanks

 

 

Karen Posted Tue 03rd of December, 2019 09:06:45 AM
The link that you sent does not help me, it is from 2012. Do you have something more current? Please let me know. Best Regards, Karen
SuperCoder Answered Wed 04th of December, 2019 04:11:36 AM

Hi,

 

Thank you for additional query.

 

As per CMS, Fundus photography is a bilateral service on the Medicare Physician Fee Schedule Database. Services performed unilaterally are subject to a reduction in fee. [Use –52 modifier to indicate unilateral service; -RT and –LT are not required in this circumstance.

 

Read the below CMS Local Coverage Article, Under heading: Article Guidance

>https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53060&ver=20&DocID=A53060&bc=gAAAABAAgAAA

 

CPT® code 92250 describe services that are performed bilaterally. Modifier 50 is never appropriate with these codes. Modifiers LT and RT should only be used if a unilateral service is performed.

 

Read the below CMS Local Coverage Article, Under heading: For claims submitted to the Part B MAC

>https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52398&ver=7&Date;=&DocID=A52398

 

 

Also, the MUE of this code is 1, which indicates that no more than 1 unit of service should be reported on the date of encounter.

 

Note: Kindly check with your payer for any specific reimbursement guideline(s) for CPT® code 92250; if any.

 

 

 

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