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
Use the current payer fee schedule for this code, locality, service setting and date of service.
Rates and patient responsibility depend on the payer and service. No unsourced national average is presented here.
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
Verify CPT 92014 against official sources
Use the code set and payer policy applicable to the date of service. This educational reference is not a coverage decision or a substitute for a qualified coding review.
- CMS Physician Fee Schedule: select the year, locality and service setting before looking up payment information.
- CMS NCCI edits and manuals: check the applicable code-pair edits and modifier instructions.
- Medicare Coverage Database: find relevant coverage and documentation policies.
- AMA CPT resources: consult the current licensed code set.
A practical documentation check
- Match the documented service to the code definition.
- Confirm patient status, laterality, components and any required interpretation.
- Check coverage, edits and payer-specific requirements.
- Have the responsible clinician or billing reviewer resolve discrepancies before submission.
Editorial sources updated September 15, 2026. Published by Jelo.
Jelo’s AI scribe is an upcoming add-on from $70/month. It is being developed to assist with documentation and code suggestions; clinicians and billing staff must verify every code. It is not included in the live platform subscription.
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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
Verify suggested diagnoses against the current ICD-10-CM set and the documented encounter. A listed diagnosis does not by itself establish medical necessity or payer coverage.
| 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 |