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Ophthalmology and Optometry Coding Alert

Reader Question:

Retina Tomograph II

Published on Mon Dec 24, 2012

Question: We recently purchased the Retina Tomograph II. I know that the procedure code is 92135 and is unilateral. Do I receive full reimbursement for both eyes, or is it 100 percent for the first and 50 percent for the second? Would I bill this as 92135-50? Also, how do I code a subsequent 92135? Do I use a -26 modifier? What is considered subsequent? More than one a year, or every time after the initial 92135?

Georgia Subscriber

Answer: You are correct, 92135 (scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral) is a unilateral code in the Medicare program. As a unilateral testing code, when two services are billed to Medicare, both services are supposed to be approved at 100 percent of the Medicare fee schedule amount.

Most Medicare carriers prefer that you bill the [...]
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