Ophthalmology and Optometry Coding Alert

Question: We reported 92134-50 and we only received unilateral payment. Should we have reported it with the LT and RT modifiers instead?

Codify Subscriber

Answer: No. This test is inherently bilateral, so the reimbursement you collect for the code accounts for what is involved in scanning both eyes. Therefore, when your eye care physician performs the scan bilaterally, you should only report the code once. Do not report 92134 either on two lines — one line with modifier RT (Right side) appended and the other line with LT (Left side) appended — or on one line with modifier 50 (Bilateral procedure) appended.

In addition, 92134 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina) has a bilateral modifier indicator of “2” in Medicare’s Physician Fee Schedule. This means that the usual bilateral payment adjustment does not apply. Medicare (and payers who follow Medicare rules) will only reimburse the allowable amount for a single code or one unit of service.