How To Use CPT Code 95060

CPT 95060 describes the ophthalmic mucous membrane tests performed by a healthcare provider to determine allergic reactions in the patient’s eye. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95060?

CPT 95060 can be used to describe the ophthalmic mucous membrane tests conducted by a healthcare provider. These tests involve introducing an allergenic extract into the conjunctiva or inner lining of the eye to observe any allergic reactions, such as redness and itching. The results of these tests help the provider determine the appropriate medications to recommend to the patient.

2. Official Description

The official description of CPT code 95060 is: ‘Ophthalmic mucous membrane tests, clinical responsibility of a provider, technical component only.’

3. Procedure

1. The healthcare provider introduces an allergenic extract into the conjunctiva or inner lining of the patient’s eye.
2. The provider observes the patient’s eye for any allergic reactions, such as redness and itching.
3. The provider records the results of the test to aid in determining the appropriate medications for the patient.

4. Qualifying circumstances

CPT 95060 is used when a healthcare provider conducts ophthalmic mucous membrane tests to determine allergic reactions in the patient’s eye. These tests are typically performed to identify the allergens causing a specific reaction and assess the severity of the reaction. The provider must have the clinical responsibility for conducting the test, and this code represents the technical component of the service only.

5. When to use CPT code 95060

CPT code 95060 should be used when a healthcare provider performs ophthalmic mucous membrane tests to assess allergic reactions in the patient’s eye. It should not be used for Schirmer’s tear testing, as this is typically included in the office visit or eye exam code. Modifier 26 or TC should not be appended to CPT 95060, as it represents the technical component of the service only.

6. Documentation requirements

To support a claim for CPT 95060, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for ophthalmic mucous membrane tests
• Details of the allergenic extract used
• Date and time of the test
• Observations of the patient’s eye during the test
• Results of the test

7. Billing guidelines

When billing for CPT 95060, ensure that the provider has the clinical responsibility for conducting the test. Modifier 26 or TC should not be appended to this code, as it represents the technical component of the service only. It is important to note that CPT 95060 should not be reported with other codes, such as Schirmer’s tear testing. Providers should review payer guidelines for specific billing requirements and consider the location of the testing when coding these tests.

8. Historical information

CPT 95060 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider conducting ophthalmic mucous membrane tests to assess allergic reactions in a patient’s eye.
2. A provider introducing an allergenic extract into the conjunctiva of a patient’s eye and observing for any redness or itching.
3. A healthcare professional performing ophthalmic mucous membrane tests to determine the allergens causing a patient’s eye reaction.
4. A provider recording the results of ophthalmic mucous membrane tests to aid in recommending appropriate medications for the patient.
5. A healthcare provider conducting ophthalmic mucous membrane tests to assess the severity of a patient’s allergic reaction in the eye.
6. A provider introducing an allergenic extract into the inner lining of a patient’s eye and observing for any signs of an allergic reaction.
7. A healthcare professional performing ophthalmic mucous membrane tests to identify the specific allergens causing a patient’s eye symptoms.
8. A provider recording the results of ophthalmic mucous membrane tests to determine the most suitable treatment options for the patient.
9. A healthcare provider conducting ophthalmic mucous membrane tests to assess the effectiveness of a patient’s current allergy medications.
10. A provider introducing an allergenic extract into the conjunctiva of a patient’s eye and documenting any allergic reactions observed during the test.