92025
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.34
Facility
$37.07
Non-Facility
$37.07
Documentation Required
- Claims for a diagnostic test performed to prepare for a non-covered procedure must be submitted using the diagnostic test code with the -GY modifier to indicate the service is statutorily non-covered (example: CPT 92025 + -GY).
- Follow the referenced Medicare billing guidance in the Internet Only Manual (IOM) Medicare NCD Manual, Pub 100-03 Chapter 1 Part 1 Section 10.1 and IOM Medicare Claims Processing Manual, Pub 100-04 Chapter 32 Section 120 for additional documentation and billing rules.
- For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
- The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
Key Coverage Criteria
- When a diagnostic test is performed solely to prepare for a non-covered service, report the diagnostic test as non-covered using the appropriate code with a -GY modifier (example: CPT 92025 + -GY for computerized corneal topography).
- Example: when planning cataract surgery with a non-covered presbyopia- and astigmatism-correcting intraocular lens, computerized corneal topography (CPT 92025) performed for that purpose should be reported as non-covered with modifier -GY.
- Computerized corneal topography is billable when performed as a diagnostic test for corneal conditions and the claim includes a diagnosis code that best describes the patient's condition for which the service was performed.
- Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
- Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.
- Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.
11 Active Policies
L33693 — Peripheral Venous Ultrasound
J09
L35007 — Vestibular and Audiologic Function Studies
J12
L35434 — Oximetry Services
J12
L35451 — Peripheral Venous Ultrasound
J12
L37371 — Electroretinography (ERG)
Related Codes
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