Ophthalmology and Optometry Coding Alert

Question: If a patient has a visual field done on only one eye, do we need to use modifier -52?

Wisconsin Subscriber

Answer: Yes. The codes 92081-92083 (visual field examination, unilateral or bilateral, with interpretation and report) for limited, intermediate and extended examinations are all considered bilateral procedures in the Medicare program. The use of the term bilateral means that payment for the service code includes payment for both eyes. When reporting the service on an electronic or paper claim, submission of the code 92081, 92082 or 92083 without a modifier communicates to the carrier that the service was performed on both eyes.

When a bilateral procedure is performed on only one eye, the claim needs to represent that a reduced service was provided and that is what modifier -52 is for. The modifier is viewed by most Medicare carriers as an informational modifier, not a payment modifier, and therefore does not result in a reduction in the approved amount for the service. A handful of carriers, such as CIGNA in North Carolina, treat the -52 modifier as a payment modifier and will reduce the allowance to 50 percent of the Medicare fee schedule when it applies to bilateral codes.