Complete Optometry CPT Codes List 2026 (92000–92499 + Billing Guide)
Eye Exam CPT Codes (92002–92014)
The four core optometry eye exam CPT codes are the 9200x series — split by patient status (new vs. established) and exam type (comprehensive vs. intermediate). Understanding when to use each is the single most important billing decision in optometry.
CPT Code | Description | Patient Status | Exam Level | Medicare | Vision Plans |
|---|---|---|---|---|---|
92004 | Comprehensive ophthalmological examination | New patient | Comprehensive | Not covered (routine) | Covered |
92014 | Comprehensive ophthalmological examination | Established | Comprehensive | Not covered (routine) | Covered |
92002 | Intermediate ophthalmological examination | New patient | Intermediate | Not covered (routine) | Sometimes |
92012 | Intermediate ophthalmological examination | Established | Intermediate | Not covered (routine) | Sometimes |
When to Bill Comprehensive (92004 / 92014) vs. Intermediate (92002 / 92012)
The distinction between comprehensive and intermediate is based on the scope of the examination documented — not the time spent:
Comprehensive (92004, 92014): Requires documentation of all of the following — general medical observation, patient history (ocular and systemic), external ocular examination, ophthalmoscopy (with mydriasis documented when indicated), gross visual field testing, and a basic sensorimotor examination.
Intermediate (92002, 92012): Used for evaluation of a new or existing condition with a diagnostic or treatment program — but does NOT require all components of a comprehensive exam. Appropriate for follow-up visits, urgent visits for a specific complaint, or minor issue exams.
Common Audit Trigger
Billing 92004 or 92014 for every visit without documentation to support the comprehensive level is a common audit trigger. The chart note must support all required components — particularly ophthalmoscopy and sensorimotor exam documentation.
New vs. Established Patient: The 3-Year Rule
A patient is considered "new" if they have not received professional services from the physician (or any other physician of the same specialty in the same group practice) within the previous 3 years. If a patient hasn't been seen in 3+ years, use the new patient codes (92004 or 92002) even if they were previously a patient. See Jelo's billing tools — the EHR automatically tracks patient status for you.
Refraction: CPT 92015
CPT 92015 — Determination of refractive state — covers the refraction portion of the eye exam. This is one of the most commonly misunderstood codes in optometry billing.
CPT Code | Description | Medicare | Medical Insurance | Vision Plans |
|---|---|---|---|---|
92015 | Determination of refractive state | Not covered (excluded) | Not covered (most plans) | Covered |
Medicare: Refraction is explicitly excluded from Medicare coverage by statute. It is non-covered, not just not medically necessary. Medicare patients may be charged for refraction as a patient-pay service with proper ABN (Advance Beneficiary Notice) handling.
Vision plans (VSP, EyeMed, Davis Vision): Refraction is covered as part of the routine vision exam benefit. It is typically included in the exam allowance — not a separate billable line item for most vision plans.
Medical insurance: Most commercial medical plans follow Medicare's exclusion of refraction. Exceptions exist — verify with each payer.
Contact Lens CPT Codes (92310–92326)
Contact lens fitting codes cover the fitting evaluation, follow-up visits, and prescription of contact lenses. These are distinct from the eye exam itself.
CPT Code | Description | Medicare | Notes |
|---|---|---|---|
92310 | Prescription of optical and physical characteristics of and fitting of contact lens(es), with medical supervision of adaptation; corneal lens, both eyes | Not covered | Most commonly billed contact lens fitting code |
92311 | Prescription and fitting of contact lens(es); corneal lens, one eye only | Not covered | Use when fitting one eye only |
92312 | Prescription and fitting of contact lens(es); corneal lens for aphakia, both eyes | Covered (aphakia) | Medicare covers aphakic contact lens fitting |
92313 | Prescription and fitting of contact lens(es); corneoscleral lens | Not covered (routine) | Scleral lens fitting — medical necessity may apply |
92314 | Prescription of optical and physical characteristics of contact lens(es) with fitting and medical supervision; by ophthalmologist or optometrist (separate from 92310–92313) | Not covered | Use when examination is performed by different provider than fitting |
92326 | Replacement of contact lens | Not covered | Lost or damaged lens replacement only — no fitting performed |
Contact Lens Fitting vs. Contact Lens Materials
The CPT codes above cover the fitting service. Contact lens materials (the actual lenses sold) are billed separately as supplies — typically using HCPCS codes V2500–V2599 for soft lenses. The fitting fee and materials are separate transactions. Ensure your practice's fee schedule separates fitting fees from materials revenue for accurate financial reporting.
Visual Field Testing: CPT 92081–92083
CPT Code | Description | Medicare | Notes |
|---|---|---|---|
92081 | Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Amsler grid, perimetry) | Covered (medical dx) | Confrontation VF, Amsler grid, limited automated |
92082 | Visual field examination; intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program) | Covered (medical dx) | Suprathreshold screening programs |
92083 | Visual field examination; extended examination (e.g., threshold, or suprathreshold testing, single determination, automated) | Covered (medical dx) | Full threshold HVF — most commonly billed VF code |
Visual field testing (92083 in particular) is one of the most commonly billed ancillary procedures in optometry. Key billing rules:
A written interpretation and report must be in the chart — not just the printout. The interpretation must be separate from the machine-generated result.
Bilateral testing is billed once with modifier -50 if both eyes are tested. Some payers require separate line items per eye.
Medical necessity documentation is required — diagnosis codes indicating glaucoma, glaucoma suspect, visual field defect, or neurological indication must be linked.
OCT Imaging CPT Codes (92133–92134)
CPT Code | Description | Medicare | Interpretation Required |
|---|---|---|---|
92133 | Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral | Covered (medical dx) | Yes — written report required |
92134 | Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral | Covered (medical dx) | Yes — written report required |
OCT is widely performed in optometry for glaucoma monitoring (92133 — optic nerve/RNFL) and retinal pathology (92134 — macula/retina). Both codes require:
An interpretation and written report documented separately from the machine output. The chart note must contain a clinical interpretation — not just "OCT performed."
A medical diagnosis that supports the clinical indication. Glaucoma suspect (H40.0x), glaucoma (H40.xx), macular degeneration (H35.3x), and diabetic retinopathy (E11.311 etc.) are the most common supporting diagnoses.
92133 and 92134 can be billed on the same day as the eye exam when medically necessary and properly documented.
Other Common Optometry Procedure Codes
CPT Code | Description | Medicare |
|---|---|---|
92100 | Serial tonometry (separate procedure); with multiple measurements of intraocular pressure, over an extended period of time, with interpretation and reports | Covered (medical dx) |
92235 | Fluorescein angiography (FA) with interpretation and report, unilateral or bilateral | Covered (medical dx) |
92250 | Fundus photography with interpretation and report | Covered w/ medical dx |
92285 | External ocular photography with interpretation and report for documentation of medical progress (e.g., corneal disease, exposure keratitis) | Covered (medical dx) |
92286 | Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis | Covered (medical dx) |
92499 | Unlisted ophthalmological service or procedure | Case by case |
65205 | Removal of foreign body, external eye; conjunctival superficial | Covered |
65210 | Removal of foreign body, external eye; conjunctival embedded (non-perforating) | Covered |
65220 | Removal of foreign body, external eye; corneal, without slit lamp | Covered |
65222 | Removal of foreign body, external eye; corneal, with slit lamp | Covered |
Medical E&M Codes for Medical Optometry
Optometrists treating medical eye conditions — dry eye disease, glaucoma, diabetic eye exams, anterior segment conditions — can bill using Evaluation and Management (E&M) CPT codes (99xxx) in addition to or instead of the ophthalmological codes (9200x). Key scenarios:
Medicare patients with medical diagnoses: Bill 99xxx E&M codes rather than 9200x eye exam codes, since 9200x is not covered by Medicare for routine care but 99xxx IS covered when linked to a medical diagnosis.
Diabetic eye exams: Bill under E&M with diagnosis code Z01.01 (encounter for examination of eyes and vision following failed vision screening) + the appropriate diabetic retinopathy code.
Glaucoma management visits: Follow-up visits for established glaucoma patients are typically billed as 99213 or 99214 with appropriate glaucoma diagnosis codes.
CPT Code | Description | Typical OD Use |
|---|---|---|
99202 | Office visit, new patient; straightforward medical decision making (or 15–29 minutes total time) | Simple new patient medical visit |
99203 | Office visit, new patient; low medical decision making (or 30–44 minutes) | New patient with minor medical condition |
99204 | Office visit, new patient; moderate medical decision making (or 45–59 minutes) | New patient with moderate medical condition |
99213 | Office visit, established patient; low medical decision making (or 20–29 minutes) | Follow-up glaucoma, DED management |
99214 | Office visit, established patient; moderate medical decision making (or 30–39 minutes) | Complex established patient medical visit |
Common Denial Reasons & How to Fix Them
92004 / 92014
Exam Code Denied
Routine vision exam billed to medical insurance
Verify whether patient has vision coverage separate from medical; bill vision plan instead
92015
Refraction Denied by Medicare
Refraction is a non-covered service under Medicare
Issue ABN before service; collect as patient pay; do not bill Medicare
92134
OCT Denied — No Interpretation
Missing written interpretation and report in chart
Document a clinical interpretation in the chart note, separate from the machine output
92083
Visual Field Denied
Diagnosis code does not support medical necessity
Link to glaucoma, glaucoma suspect, or visual field defect diagnosis; ensure report is documented
92310
Contact Lens Fitting Denied
Billed to medical insurance (not covered for routine CL fitting)
Bill to vision plan; for medically necessary CL (keratoconus, post-surgical), bill with appropriate medical diagnosis
92004 + 99204
Duplicate Exam Code on Same Day
Both ophthalmological exam and E&M billed same date
Bill one code per visit; if genuinely separate issues, append modifier -25 and ensure separate documentation
Jelo Auto-Suggests CPT Codes as You Document
No more manual code lookup. Jelo's billing engine suggests the right exam code, procedure codes, and modifiers based on what you documented — reducing errors and missed charges.