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2017 ICD-10 Diagnosis Code Set Loaded     


4/3/2017 NCD Edits Loaded     


2017 Lab Fee Schedule     


2017-B DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for Q2/2017     


2017 April ASC Fee Schedule Updated     


April 2017 ASP Drug Pricing Updated     


Q2 2017 CCI Edits Loaded     


Q2 2017 MUE Edits Loaded     


LCD Database Current Through 06/19/2017     

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92019
Quick jump to procedure code: Printer Friendly Version
92025

92020: Special eye evaluation CPT® 92020: GONIOSCOPY (SEPARATE PROCEDURE)

Short Description: Special eye evaluation

--

CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2017 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$ 27.28
$ 21.53

2017 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $100.02


*Based on National 2013 Medicare Part B submitted claims.
2017 APC Code: 5734
Level 4 Minor Procedures

2017 OPPS Status Indicator: Q1

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
13.6%
H40.013
Open angle with borderline findings, low risk, bilateral
124-125
11.5%
H4011X2
This diagnosis code is no longer active.
11.1%
H40.033
Anatomical narrow angle, bilateral
124-125
11.0%
H4011X1
This diagnosis code is no longer active.
6.7%
H4011X3
This diagnosis code is no longer active.
5.7%
H40.003
Preglaucoma, unspecified, bilateral
124-125
3.9%
H40.023
Open angle with borderline findings, high risk, bilateral
124-125
3.8%
H40.053
Ocular hypertension, bilateral
124-125
2.6%
H25.13
Age-related nuclear cataract, bilateral
124-125
1.4%
H4011X0
This diagnosis code is no longer active.

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

92020 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Column 1 CCI Edits for 92020
Denied Codes (1) Effective Modifier
Accepted (2)
36591 Draw blood off venous device 10/01/2015 No
36592 Collect blood from picc 10/01/2015 No
99211 Office/outpatient visit est 04/01/2003 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 92020.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 92020
Denied Codes (1) Effective Modifier
Accepted (2)
65855 Trabeculoplasty laser surg 01/01/1996 Yes
92018 New eye exam & treatment 01/01/2002 No
92019 Eye exam & treatment 01/01/2002 No
92285 Eye photography 01/01/1996 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 92020.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 92020

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: CMS Policy CMS Policy Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   92020 Top 5 Ordering Providers National*
HOWARD PERELL -GLEN BURNIE,MD 2,504
STANLEY BYKOV -BROOKLYN,NY 2,473
DAVID PINHAS -BROOKLYN,NY 2,085
HARRY HUANG -BETHESDA,MD 1,934
THOMAS CALECA -CLEARWATER,FL 1,892

*Based on 2015 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 92020*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 926,883
Total Services Denied 2015: 52,554 (5.7%)
National Charges Submitted 2015: $ 57,826,452.43
National Charges Allowed 2015: $ 23,933,531.74
National Average (No Modifier) Fee Submitted 2015: $ 62.63
National Average (No Modifier) Fee Allowed 2015: $ 27.37
National Average (26) Fee Submitted 2015: $ 81.33
National Average (26) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Ophthalmology 760,014 82.0% $ 64.45 38,488 5.1%
Optometry
(revised 10/93 to mean optometrist)
164,532 17.8% $ 52.87 13,859 8.4%
Internal medicine 624 0.1% $ 50.51 12 1.9%
Multispecialty clinic or group practice 608 0.1% $ 63.32 84 13.8%
Neurology 327 0.0% $ 61.41 5 1.5%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 892,972 96.3% $ 62.14 50,260 5.6%
Outpatient hospital 24,495 2.6% $ 76.29 1,088 4.4%
Nursing facility 5,731 0.6% $ 50.20 530 9.2%
Skilled nursing facility 1,147 0.1% $ 48.33 147 12.8%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 859,461 92.7% $ 62.63 46,598 5.4%
59 - Distinct Procedural Service 44,146 4.8% $ 57.15 2,962 6.7%
RT - Right Side 4,325 0.5% $ 59.92 1,116 25.8%
AQ 4,250 0.5% $ 60.05 364 8.6%
GC 3,351 0.4% $ 81.24 223 6.7%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
06/24/2017 02:06:22 54.159.66.70

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