CPT Code 92014: Comprehensive Eye Exam, Established Patient
Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
CPT 92014 reports a comprehensive eye examination for an established patient (seen within the last 3 years by a provider in your practice). Like 92004, it requires a full medical evaluation of the visual system plus initiation or continuation of a diagnostic and treatment program.
When to use CPT 92014
Use CPT 92014 for an established patient receiving a comprehensive eye exam with continuation or initiation of a diagnostic and treatment program. Requires all comprehensive ophthalmological elements.
Documentation requirements
- Established patient (seen within 3 years by any provider of same specialty in your practice)
- Chief complaint and interval history
- Visual acuity (distance and near)
- External and internal examination
- Gross visual fields
- Basic sensorimotor examination
- Biomicroscopy where indicated
- Tonometry where indicated
- Initiation or continuation of a diagnostic and treatment program
Reimbursement
$100 to $140 (varies by locality and payer)
National averages only. Rates vary by locality, payer, and fee schedule. Verify with your contracted payers.
Common modifiers
- -25
- -57
- -GA
- -GY
Common denial reasons for CPT 92014
- Patient was actually new (should be 92004)
- Missing required comprehensive elements
- Frequency limit exceeded for payer
- Diagnosis not medically necessary
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