TMPPM 2011 > Vision and Hearing Services Handbook > Vision Care Professionals > Services/Benefits, Limitations, and Prior Authorization > Vision Testing > Ophthalmoscopy, Angioscopy or Angiography

   
 

4.3.5.8 Ophthalmoscopy, Angioscopy or Angiography

Routine ophthalmoscopy is part of general and special ophthalmologic services whenever indicated and may be reimbursed using the following procedure codes:

Procedure Codes

92225

92226

92230

92235

92240

92250

92260

Ophthalmoscopy and fluorescein angioscopy or angiography (procedure codes 92225, 92226, 92230, and 92235) are considered unilateral procedures and may be reimbursed for a quantity of two if both the left and right eyes are evaluated. If two services are billed for the same date of service, one may be reimbursed at the full rate, and the other may be reimbursed at half rate.

Procedure codes 92225 and 92226 may be reimbursed once per eye, per day when they are billed by any provider.

Procedure codes 92225 and 92226 must be billed with modifier LT or RT to identify the eye on which the service was performed.

Ophthalmoscopy, angioscopy, and angiography procedure codes are subject to CMS NCCI relationships. The following relationships are exceptions to the published NCCI relationships:

The procedure codes in Column A of the following table will be denied if they are billed with the same date of service by the same provider as the corresponding procedure codes in Column B:

Column A (Denied)
Column B

92230

92235

92240

92230, 92250

92132, 92133, 92134

92250

Refer to: The CMS NCCI web page at www.cms.hhs.gov/NationalCorrectCodInitEd/ for the published correct coding guidelines and specific applicable code combinations.


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