Ophthalmology CPT Codes
Eye care is the only specialty with its own exam codes: the 92002–92014 family sits alongside regular E&M codes, and providers choose between the two systems visit by visit. Add refraction, which Medicare famously never covers, and cataract surgery with its co-management arrangements, and ophthalmology billing has quirks no other specialty deals with.
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Ophthalmology CPT codes
Eye Exam, New Patient, Comprehensive
Complete new-patient ophthalmological evaluation, typically dilated.
Eye Exam, Established Patient, Comprehensive
Complete established-patient exam. The routine annual for existing patients.
Refraction
Determination of refractive state. Not covered by Medicare; usually patient responsibility.
Visual Field Examination, Extended
Threshold perimetry for glaucoma and neurological workups. Bilateral by definition.
OCT, Retina
Optical coherence tomography of the retina, both eyes. Frequency-limited by most payers.
Cataract Surgery with IOL, Standard
Extracapsular cataract removal with intraocular lens. 90-day global period; co-management uses modifiers 54/55.
Codes in blue have full detail pages with documentation requirements, billing mistakes, and FAQ.
Ophthalmology billing notes
Every visit is a choice: eye codes (92002–92014) or E&M codes (99202–99215). Eye codes have simpler documentation rules; E&M sometimes pays better for medically complex visits. Pick per encounter, not by habit.
Refraction (92015) is not covered by Medicare and many medical plans, period. Collect it from the patient, and tell them before the exam rather than after the statement goes out.
Cataract surgery (66984) carries a 90-day global period. When the optometrist handles post-op care, the surgeon bills with modifier 54 (surgical care only) and the optometrist bills with 55 (post-op management).
Diagnostic tests like OCT (92134) and visual fields (92083) are bilateral by definition: one code covers both eyes. Frequency limits apply, especially for glaucoma monitoring.
Eye codes distinguish new versus established patients and intermediate versus comprehensive levels. A comprehensive exam (92004/92014) requires a full dilated evaluation, and payers audit for it.
Frequently asked questions about ophthalmology billing
Should I bill eye codes or E&M codes for an office visit?▼
Whichever the documentation supports and pays appropriately for that visit. Eye codes suit routine and follow-up eye exams with their simpler requirements; E&M often fits medically complex visits better. The mistake is defaulting to one family for everything instead of choosing per encounter.
Why do patients pay separately for refraction?▼
Because Medicare and most medical insurance classify refraction (92015) as non-covered vision care, not medical care. The charge is the patient's unless they have a vision plan that picks it up. Practices that don't explain this upfront spend a lot of time on billing calls.
How does cataract co-management billing work?▼
The surgeon bills 66984 with modifier 54 for the surgery and immediate care, and the co-managing optometrist bills the same code with modifier 55 for the post-op period, with the 90-day global payment split between them. The transfer of care needs to be documented on both sides.
Sources
- Code set structure and updates: American Medical Association — CPT
- Fee schedule and component billing rules: CMS Medicare Physician Fee Schedule
- How we research and verify: our editorial policy
CPT® is a registered trademark of the American Medical Association. Content on this page is original educational writing, not a reproduction of AMA-copyrighted descriptions. Verify codes and payer rules before billing.