The following article outlines how CPT code 92136 must be submitted when performed unilaterally or bilaterally.
CPT code 92136 and CPT code 92136 with HCPCS modifier TC are assigned the BILAT 2 indicator on the Medicare Physician Fee Schedule Database (MPFSDB), which means the payment is already calculated at the bilateral rate. CPT code 92136 includes two technical components and one professional component.
CPT code/modifier 92136-26 is assigned the BILAT 3 indicator on the MPFSDB, which means the payment is calculated at the unilateral rate.
Performed Bilaterally:
If the technical and professional components were performed on both eyes on the same day, submit the claim as follows:
| Date of Service | CPT Code/Modifier | Days/Units |
| 7/3/2009 |
92136 |
'1' |
| 7/3/2009 |
92136-26 |
'1' |
If a bilateral technical component and a unilateral professional component were performed on the same day, but the other unilateral professional component was performed a different day, submit the claim as follows:
| Date of Service | CPT Code/Modifier | Days/Units |
| 7/3/2009 |
92136 |
'1' |
| 7/10/2009 |
92136-26 |
'1' |
Performed Unilaterally:
If CPT code 92136 or CPT code 92136 with HCPCS modifier TC is performed unilaterally, add CPT modifier 52 to indicate the bilateral procedure was performed on one eye only. CPT 92136-26 represents a unilateral service, so CPT modifier 52 is not appropriate for it.
It is no longer necessary to submit documentation explaining use of CPT modifier 52 for CPT code 92136 or CPT code 92136 with HCPCS modifier TC. We will conclude that use of the modifier is intended to represent that the service was performed unilaterally.
Submit the claim as follows:
Unilateral technical component:
| Date of Service | CPT Code/CPT & HCPCS Modifier | Days/Units |
| 7/3/2009 |
92136-TC52 |
'1' |
* TC is a HCPCS modifier and 52 is a CPT modifier.
Unilateral technical component and Unilateral professional component:
| Date of Service | CPT Code/Modifier | Days/Units |
| 7/3/2009 |
92136-52 |
'1' |
Unilateral professional component:
| Date of Service | CPT Code/Modifier | Days/Units |
| 7/3/2009 |
92136-26 |
'1' |