Definition. 92072 Fitting of contact lens for management of keratoconus; initial fitting. This definition covers the fitting of a prescriptive or nonprescriptive contact lens to treat keratoconus in order to reshape the cornea to correct the patient’s vision.
Payment. Although published with unilateral payment, the intent of the code was for bilateral payment. CMS
has been notified of the error. The national average payment is $87 if the fitting is done in an office; $70 if in a facility.
National CCI edits. Do not report 92072 in conjunction with 92071 or with the technician code 99211.
Modifiers. Submit 92072 with modifiers –RT, –LT or –50.
Diagnosis codes.
371.62 Keratoconus, acute hydrops.
Supervision rules don’t apply. Typically performed by a physician.
Further fittings. Any subsequent fittings should be reported using either E&M or Eye codes.
Report supply of the lens separately.
You can use the following codes:
• 99070 Supplies and materials,
• 92326 Replacement of contact lens,
• V2500Contact lens, PMMA, spherical, per lens,
• V2501 Contact lens, PMMA, toric or prism ballast, per lens,
• V2502Contact lens, PMMA, bifocal, per lens,
• V2510Contact lens, gas permeable, spherical, per lens,
• V2511Contact lens, gas permeable, toric, prism ballast, per lens,
• V2512Contact lens, gas permeable, bifocal, per lens,
• V2513Contact lens, gas permeable, extended wear, per lens,
• V2530Contact lens, scleral, gas impermeable, per lens,
• V2531Contact lens, gas permeable, per lens or
• V2599Contact lens, other type
Payment. Although published with unilateral payment, the intent of the code was for bilateral payment. CMS
has been notified of the error. The national average payment is $87 if the fitting is done in an office; $70 if in a facility.
National CCI edits. Do not report 92072 in conjunction with 92071 or with the technician code 99211.
Modifiers. Submit 92072 with modifiers –RT, –LT or –50.
Diagnosis codes.
371.62 Keratoconus, acute hydrops.
Supervision rules don’t apply. Typically performed by a physician.
Further fittings. Any subsequent fittings should be reported using either E&M or Eye codes.
Report supply of the lens separately.
You can use the following codes:
• 99070 Supplies and materials,
• 92326 Replacement of contact lens,
• V2500Contact lens, PMMA, spherical, per lens,
• V2501 Contact lens, PMMA, toric or prism ballast, per lens,
• V2502Contact lens, PMMA, bifocal, per lens,
• V2510Contact lens, gas permeable, spherical, per lens,
• V2511Contact lens, gas permeable, toric, prism ballast, per lens,
• V2512Contact lens, gas permeable, bifocal, per lens,
• V2513Contact lens, gas permeable, extended wear, per lens,
• V2530Contact lens, scleral, gas impermeable, per lens,
• V2531Contact lens, gas permeable, per lens or
• V2599Contact lens, other type
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