CPT 92014Comprehensive 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
Jelo's exam-native AI scribe reads the findings you chart and drafts the ICD-10 codes, the assessment and the plan, then suggests whether the visit supports CPT 92014 or an E/M level. You review and sign; nothing files without you.
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Worked example: billing CPT 92014
An established patient with type 2 diabetes returns for the annual dilated exam. All comprehensive elements are documented, including the dilated fundus examination; no retinopathy is found. Bill 92014 with E11.9 as the primary diagnosis to the medical carrier, not the vision plan, and 92015 on its own line if a refraction was performed. If the same patient had come in for a red eye and only a problem-focused exam was done, 92012 or an E/M code would apply instead of 92014.
ICD-10 codes commonly paired with CPT 92014
Validated against the FY2026 ICD-10-CM set. Pick the most specific diagnosis the chart supports; payers deny exam codes billed with a diagnosis that does not establish medical necessity.
| ICD-10-CM | Description |
|---|---|
| E11.9 | Type 2 diabetes mellitus without complications |
| H35.033 | Hypertensive retinopathy, bilateral |
| H40.013 | Open angle with borderline findings, low risk, bilateral |
| H25.13 | Age-related nuclear cataract, bilateral |
| Z01.01 | Encounter for examination of eyes and vision with abnormal findings |
| H52.4 | Presbyopia |