Ophthalmology and Optometry Coding Alert

Find answers for bilateral billing questions on common ophthalmologic procedures

If you’re tired of flipping though the Medicare Physician Fee Schedule for advice every time you suspect your ophthalmologist performs a bilateral procedure, relief is at hand. Use this handy reference chart to determine which ophthalmology codes you can bill with modifiers 50, LT or RT, and which you can’t.
 
We’ve broken down the codes according to whether the Medicare Physician Fee Schedule lists them with a 0, 1 or 2 indicator, with these definitions:

0 -- You cannot append modifier 50, but you can append LT or RT.

1 -- You can append modifier 50.

2 -- The code already specifies a bilateral procedure, so you should not append modifier 50, LT or RT to denote a procedure’s bilateral nature.

3 -- When performed bilaterally, append modifier 50 or LT/RT. Reimbursement is determined at 100 percent of the allowed for each side.

Bilateral Procedure Indicator 0:

Do not report these codes bilaterally.

66990, 67221-67225, 67320-67340, 67800-67808, 92018-92019, 92025, 92311, 92313, 92315, 92317, 92325, 92326, 92499

Bilateral Procedure Indicator 1:

You may report these codes bilaterally.

65091-65755, 65770, 65772-66986, 66999, 67005-67220, 67227-67318, 67343-67715, 67810

Bilateral Procedure Indicator 2:

Do not report these codes bilaterally.

76514, 76516, 76519, 76519-TC, 92020, 92060, 92065, 92081, 92082, 92083, 92100, 92120, 92130, 92136, 92136-TC, 92140, 92250, 92260, 92265, 92270, 92275, 92283, 92284, 92285, 92286, 92287, 92312, 92316

Bilateral Procedure Indicator 3:

Report these codes with modifier 50 or LT/RT when performed bilaterally.
76510, 76511, 76512, 76513, 76519-26, 76529, 92070, 92135, 92136-26, 92225, 92226, 92230, 92235, 92240

Note: If a procedure is divided into professional (modifier 26) and technical components (TC), the components usually have the same bilateral status. Note the exceptions of 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) and 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation).
 
Medicare views the technical components of these procedures as inherently bilateral, meaning that the payment for 76519-TC or 92136-TC is based on the procedure being performed bilaterally. However, since the physician may measure the IOL strength in just one eye, 76519-26 and 92136-26 are unilateral.