• Ophthalmic Biometry


    I was wondering if you could help me with an issue with a Medicare Advantage plan. They have denied our testing for ophthalmic biometry. We filed 92136-TC and 92136-26 and identified which eye. I have filed several disputes, and those also have been denied. The payer told me the wrong modifier is being used.

    Answer:

    Each payer may have their own preference for how to bill biometry. We have heard of several plans revising their policy this summer. The Biometry Fact sheet can be reviewed on the Coding Fact Sheets and Resources webpage and outlines coding requirements per payer.

    Additional billing guidance can also be found in 2022 Fundamentals of Ophthalmic Coding and 2022 Coding Assistant: Cataract and Anterior Segment.