CPT code 92250 is considered a bilateral procedure and therefore should not be submitted with CPT modifier 50 or HCPCS modifiers RT or LT. This code has a Bilateral Indicator 2 on the MPFSDB which means the Relative Value Units (RVUs) are already based on the procedure being performed as a bilateral procedure.
- When performed bilaterally, CPT code 92250 should be submitted on a single detail line with a quantity billed of “1”.
- If CPT modifier 50 or HCPCS modifiers RT or LT are submitted with CPT code 92250, the detail line will be rejected. Rejected claims must be corrected and resubmitted as new claims.
Information regarding Bilateral Indicator 2 is available on the Modifier Lookup section (CPT Modifier 50) of this Web site.
When performed unilaterally, CPT code 92250 should be submitted with CPT modifier 52 (reduced service), a quantity billed of “1” and documentation indicating “left eye” or “right eye” must be submitted in the documentation record for electronic claims and as a separate attachment for paper claims. Do not submit HCPCS modifier RT or LT.