Blog Post

Optometric Billing-Billing Medicare for 92250

  • By Andrew Roy
  • 26 Jan, 2016

...and how to properly bill 92250 to ALL insurance companies

Optometric Billing-Billing Medicare for 92250
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: 

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)

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
By Jasmin Vasquez 09 Nov, 2017
How your optometric billing can help build your specialty clinic from the ground up.
By Jasmin Vasquez 24 Oct, 2017
Detection of early signs of glaucoma made easier with new technological advances.
By Jasmin Vasquez 20 Oct, 2017
Upgrading diagnostic tools to help improve your optometric billing.
By Jasmin Vasquez 13 Oct, 2017
Optical coherence tomography (OCT) scanning has come a long way in the development of its technology in the last two decades. How will these new advances in OCT affect how you practice optometry and your optometric billing?
By Blog Owner 01 May, 2017
Just a little note of things to keep in mind when billing with optometric.
By Blog Owner 24 Apr, 2017
"Everyone will come to you and you will be the one who refers them to different specialties". Maybe the eyes are more than just a window to the soul?
By Blog Owner 18 Apr, 2017
Eliminate or delegate things you spend your time on that don't improve your bottom line. Outsource things you must do well but can't/don't.
By Blog Owner 11 Apr, 2017
Received a question from a provider regarding Harvard Pilgrim
By Blog Owner 04 Apr, 2017
Some things to look for and some things to avoid when seeking optometric billing services.
By Blog Owner 27 Mar, 2017
When performing routine eye exams on Aetna Patients it is a good idea to get in the habit of using Z01.00 OR Z01.01 as your diagnosis code INSTEAD of a code beginning with "H52". This is because many of Aetna's plans actually are set up to pay for routine eye exams but ONLY if the primary diagnosis is = Z01.00 OR Z01.01.
Show More
Share by: