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Reimbursement

  1. How many billing codes are applicable to the 2 mode Spectralis?
  2. What is the proper billing code for OCT/HRT procedures? I have been having trouble with billing OCT and HRT posterior eye exams. The insurance companies tell me the code I am using (92135) is no longer valid.
  3. I am noticing a significant decrease in payments on my OCT and HRT billings. Can you explain this?

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  1. How many billing codes are applicable to the 2 mode Spectralis?

    There are two applicable codes:
    92135 – Optical Coherence Tomography
    92285 – External Ocular Photography

  2. What is the proper billing code for OCT/HRT procedures? I have been having trouble with billing OCT and HRT posterior eye exams. The insurance companies tell me the code I am using (92135) is no longer valid.

    Effective January 1, 2011, the CPT code used for OCT and HRT billing 92135 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, or “SCODI”) was replaced with two new codes:

    • 92133 – SCODI, Posterior segment, optic nerve
    • 92134 – SCODI, Posterior segment, retina

    Medicare reimbursement is the same for 92133 and 92134, and the 2011 unadjusted base rate for the two codes is 1% higher than the 2010 rate was for 92135.

    There is one very significant difference between the new codes and 92135. The new codes are designated as “unilateral OR bilateral” codes, so the payment amount stays the same even if both eyes are examined. The old code, 92135, was a unilateral code, so when both eyes were scanned the payment was twice the single eye rate.

    Click here for a listing of diagnostic imaging codes and payment information.

  3. I am noticing a significant decrease in payments on my OCT and HRT billings. Can you explain this?

    Effective January 1, 2011, the CPT code used for OCT and HRT billing 92135 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, or “SCODI”) was replaced with two new codes:
    • 92133 – SCODI, Posterior segment, optic nerve
    • 92134 – SCODI, Posterior segment, retina

    Medicare reimbursement is the same for 92133 and 92134, and the 2011 unadjusted base rate for the two codes is 1% higher than the 2010 rate was for 92135.

    There is one very significant difference between the new codes and 92135. The new codes are designated as “unilateral OR bilateral” codes, so the payment amount stays the same even if both eyes are examined. The old code, 92135, was a unilateral code, so when both eyes were scanned the payment was twice the single eye rate.

    Click here for a listing of diagnostic imaging codes and payment information

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