Ophthalmology and Optometry Coding Alert

Question: Is the -YB modifier billable and payable on 92235 (fluorescein angiography [includes multiframe imaging] with interpretation and report)?

California Subscriber


Answer: Medicare provides different levels of coding along with different types of modifiers. Modifiers in the -WA through -ZZ range, with the exception of -YY (second opinion) and -ZZ (third opinion), are reserved for local assignment. Your local Medicare carrier can use these modifiers. The Health Care Financing Administration (HCFA) has reserved -H, -Q, -K and -G modifiers for national use by all providers and carriers.

The -YB modifier, a local carrier modifier used in California, designates whether you purchased a testing service that youre billing. The -YB modifier indicates that you did not purchase the test from an outside lab. In other words, you performed the test yourself. The current Medicare carrier for Southern California, Transamerica, now requires that you indicate yes or no in the box or field for Outside Laboratory. So if you perform the test yourself, indicate no in the box for outside laboratory.