On this page
- What Are Ophthalmology CPT Codes?
- Which Eye Exam and Visit Codes Do Practices Use?
- Which Diagnostic Test Codes Matter Most?
- Which Surgery and Procedure Codes Are Most Common?
- What Rules Decide Whether an Eye Code Pays?
- How Do You Choose Between 92 and 99 Codes?
- Which HCPCS Codes Do Eye Practices Use With CPT Codes?
- Which Code Guides Cover Each Service in Detail?
- Which Eye Care Codes Do Medicare and Vision Plans Treat Differently?
Key takeaways
- Eye visits can be billed with 92 eye exam codes or 99 E/M codes, and the choice changes payment and documentation.
- Diagnostic tests such as OCT, visual fields and fundus photos carry frequency limits and same-day bundling edits.
- Most eye surgery codes carry a 90-day global period, while intravitreal injection 67028 carries a 0-day global.
- Refraction (92015) and contact lens fitting are not covered by Medicare and are billed to the patient or a vision plan.
What Are Ophthalmology CPT Codes?
Ophthalmology CPT codes are the five-digit Current Procedural Terminology codes, published by the American Medical Association, that describe every eye exam, test and procedure on a claim. Each code tells the payer what was done, and its value under the Medicare Physician Fee Schedule decides what most payers pay.
Eye care uses its own exam codes as well as the standard E/M codes, so ophthalmology coding has more choices on a single visit than most specialties. Our ophthalmology medical coding services team checks those choices on every encounter.
Which Eye Exam and Visit Codes Do Practices Use?
Eye practices bill office visits with either the 92 eye exam codes or the 99 E/M codes, and both families split into new and established patients. The table lists the codes used for most eye care visits.
| Code | Description | Used for |
|---|---|---|
| 92002 | Eye exam, new patient, intermediate | A focused new problem visit |
| 92004 | Eye exam, new patient, complete | A full first exam of the visual system |
| 92012 | Eye exam, established patient, intermediate | A follow-up of a known problem |
| 92014 | Eye exam, established patient, complete | A full exam for a returning patient |
| 99202 to 99205 | Office E/M, new patient | Visits leveled by medical decision making or time |
| 99212 to 99215 | Office E/M, established patient | Medical visits with a clear decision-making level |
| 92015 | Refraction | Glasses prescription, billed separately |
The complete codes require more exam elements than the intermediate codes, and the 99 codes require documented decision making.
Which Diagnostic Test Codes Matter Most?
OCT, visual fields, fundus photography and angiography are the diagnostic tests eye practices bill most, and each one has frequency limits set by the payer. Most of these tests are billed once per date for both eyes, and several cannot be billed together on the same day.
| Code | Test | Billing rule to watch |
|---|---|---|
| 92133 | OCT of the optic nerve | Not billed with 92134 on the same date |
| 92134 | OCT of the retina | Frequency set by the payer's coverage policy |
| 92137 | OCT angiography | Not billed with 92134 for the same eye |
| 92081 to 92083 | Visual field, limited to extended | Level must match the test performed |
| 92250 | Fundus photography | Same-day edit with OCT on many payers |
| 92235 | Fluorescein angiography | Needs a documented retinal indication |
| 92020 | Gonioscopy | Common in glaucoma workups |
| 76514 | Corneal pachymetry | Usually billed once per condition |
| 92136 | Ophthalmic biometry | Used for IOL power before cataract surgery |
Every test also needs a written interpretation and a diagnosis that supports it.
Which Surgery and Procedure Codes Are Most Common?
Cataract surgery, intravitreal injections, glaucoma lasers and eyelid procedures make up most of the procedure codes eye practices bill. Each surgical code has a global period, which decides how visits around the surgery are billed.
- 66984 for standard cataract surgery with an intraocular lens, and 66982 for complex cases
- 66989 and 66991 for cataract surgery combined with a glaucoma drainage device
- 67028 for an intravitreal injection, billed with the drug's J-code and units
- 65855 for laser trabeculoplasty and 66821 for YAG capsulotomy
- 68761 for punctal plugs, reported once per eyelid with E1 to E4
- 67904 for ptosis repair and 15823 for upper eyelid blepharoplasty
Our cataract surgery billing and retina billing services pages explain how these codes are billed in practice.
What Rules Decide Whether an Eye Code Pays?
Four rules decide most eye care payments, which are laterality, bundling edits, frequency limits and global periods. A correct code can still deny if any one of these is missed.
- Laterality. Procedures and many tests need RT, LT or an eyelid modifier.
- Bundling. NCCI edits stop some code pairs from paying on the same day.
- Frequency. Local coverage determinations limit how often tests pay.
- Global periods. Visits after surgery are included unless a modifier applies.
Each of these rules is applied on the claim line through ophthalmology modifiers.
How Do You Choose Between 92 and 99 Codes?
Choose the code family the documentation supports and that the payer pays best for that visit, and never bill both for the same visit. The 92 codes are built on exam elements, while the 99 codes are leveled by medical decision making or time.
A complex medical visit with high decision making often fits a 99 code better. A full eye exam with a simple plan often fits a 92 code such as 92014 better.
Which HCPCS Codes Do Eye Practices Use With CPT Codes?
Eye practices use HCPCS codes alongside CPT codes for drugs, eyewear, contact lenses and some screening services. These Level II codes are published by CMS rather than the AMA.
- J-codes for injected drugs, billed in units next to 67028
- V2020 for frames and V2100 to V2799 for spectacle lenses
- V2500 to V2599 for contact lenses
- G0117 and G0118 for glaucoma screening in high-risk Medicare patients
- S0620 and S0621 for routine eye exams with some plans
Which code a plan expects varies, so load each plan's preferred codes into the billing system.
Which Code Guides Cover Each Service in Detail?
Each detailed guide covers one code or code group, with its documentation rules, payer rules and denial causes. These are the guides in this series.
- CPT Code 92014 for Complete Established Eye Exams. CPT 92014 description, required exam elements, payer rules and common denial reasons for established patient complete eye exams.
- CPT Code 92134 Retina OCT Billing Rules and Frequency. CPT 92134 retinal OCT billing guide covering covered diagnoses, frequency limits, bilateral payment and bundling with 92133 and 92250.
- CPT Code 92015 Refraction Billing and Who Pays for It. CPT 92015 refraction is non-covered by Medicare.
- CPT Code 92250 for Fundus Photography and How to Bill It. CPT 92250 fundus photography billing, medical necessity, bundling with OCT and ophthalmoscopy, and frequency guidance.
- CPT Code 92004 for a Complete New Patient Eye Exam. CPT 92004 requirements, new patient definition, reimbursement and when to choose 99204 instead for a new patient eye exam.
- CPT Code 92133 for Optic Nerve OCT and How to Bill It. CPT 92133 optic nerve OCT for glaucoma, covered diagnoses, frequency and the rule against billing it with 92134 on the same day.
Many of these codes also need a modifier, such as modifier 25 on a same-day exam or modifier 26 when another doctor reads a test.
Which Eye Care Codes Do Medicare and Vision Plans Treat Differently?
Medicare pays for medical eye care but excludes routine eye exams, refraction and contact lens fitting, while vision plans pay for routine exams and materials. The same exam code can be billed to either payer, depending on the reason for the visit.
A visit for a medical complaint goes to medical insurance, and a routine vision check goes to the vision plan. Our vision plan billing team routes each visit to the payer that should pay it.