BILLING PRO TIP:

Use CPT 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) – this test is performed prior to cataract surgery to help measure the axial length of the eye, the corneal curvature, and anterior chamber depth.

• Medicare pays the technical component bilaterally and pays the professional component unilaterally.

Per CMS.GOV, “Procedure code 92136 global and technical (TC) components are classified as bilateral
procedures where the bilateral adjustment does not apply, the Physician Fee Schedule amount for a global
procedure represents payment for the technical components (TC) for both eyes and one professional
component (26). The technical component procedures (TC) represent payment for both eyes. These
procedures should be reported on a single claim line without the 50 or RT/LT modifiers and if applicable
one additional line for the opposite professional component (26).”

• If a patient is having cataract surgery on both eyes, bill the initial test as 92136. Payment for this includes the technical component for both eyes and the professional component for the eye having surgery. When the patient comes back to have the other eye done, bill a 92136-26.

• The second payment is for the professional component for the second eye.

• For non-Medicare payers who do not use -26 modifier, bill 92136-RT or LT.

• May be performed by an ophthalmic technician under the supervision of a physician.

• Always verify with the MAC in your region to determine proper coding.

Does coding have you puzzled?

The Eye Med Management team stays up to date on coding changes and best practices. Learn how our team can help you avoid costly errors and see increased revenues by contacting us today.