• Watch Out for CMS Errors on CPT 76519, 92136


    Updated Feb. 1, 2017
    The Academy has learned of an error that the Centers for Medicare and Medicaid Services implemented in the 2017 payment database. The error affects payment and applies to all Medicare Administrative Contractors. CMS has corrected two other errors that affected CPT codes 92235 and 92240.

    Denials for CPT codes 76519 and 92136

    • Background: Unlike other payers, Medicare has one allowed amount for measuring both eyes and a professional component for each eye.
    • Error: The 2017 Medicare fee schedule has a “2” bilateral indicator instead of a “3” indicator for the professional (-26) component.
    • How this impacts you: Denials for the professional component of the second eye cataract surgery.
    • What to do: We are awaiting word from CMS as to whether practices should hold the claims, or submit and receive the denial.