Do you know that more than 13 million people in the USA have some kind of vision impairment or blindness? Glaucoma, diabetic retinopathy (DR), and macular degeneration are among the leading causes. So, detecting and treating these diseases on time is very important.
Optical coherence tomography (OCT) is an imaging method that physicians use to detect and treat these issues.
However, billing for this is not easy. There are many CPT codes for OCT billing; all of them are similar in their description, with just minor differences. This causes confusion for billers. One such code is CPT code 92133.
That’s why we have created this detailed guide on code 92133, which is one of the most used codes for OCT scans. In this guide, we will explain what this code is and how you can use it effectively in your claims.
CPT Code 92133 – Description
CPT code 92133 is defined as:
“Computerized ophthalmic diagnostic imaging (e.g., optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; optic nerve.”
This is the new and updated definition of the code. Before 2025, the descriptor didn’t mention “optical coherence tomography”. Rather, it used the phrase “computerized ophthalmic diagnostic imaging”. However, in the new definition, this changes because the imaging tech has also changed.
In simple terms, code 92133 is used to bill an OCT scan of the back portion of the eye, specifically the optic nerve head. While it can be used for various reasons, the most frequent one is to detect glaucoma.
Here are the key things that define this code:
- One Unit, Either or Both Eyes: Whether you image one eye or both, you can only bill one unit of this code per session.
- Optic Nerve Only: The scan under code 92133 is used only to image the optic nerves. If the macula or the retinal layers are also included in the scan, use 92134 or other more relevant codes.
- Interpretation Required: 92133 doesn’t just cover the technical imaging. It also includes the physician’s interpretation of the images and reporting.
What makes 92133 different from 92134 is that 92133 is for optic nerves while 92134 is basically used to image the retina. This is a very common confusion among billers, so make sure you remember this point.
Scenarios Where CPT Code 92133 is Applicable
Let’s look at a couple of real-world scenarios in which CPT code 92133 can be used:
Glaucoma Monitoring
Suppose a patient has bilateral primary open-angle glaucoma. It is in the mild stage. The patient visits his ophthalmologist after 6 months for a routine monitoring visit. The physician checks the eyes manually first, and the patient seems asymptomatic. Moreover, there aren’t any major changes in the vision. However, glaucoma is a progressive disease, so it requires monitoring.
Hence, the physician performs an OCT scan of both eyes. He takes all the measurements and compares the readings with the previous scans. Everything seems as it was, and the disease hasn’t progressed. The physician then creates a detailed report of the scans.
In this scenario, the billing department can use CPT code 92133 to bill the diagnostic imaging.
Ischemic Optic Neuropathy
Let’s look at another scenario. Suppose a patient rushed to an eye clinic. He shares with the ophthalmologist that he had a sudden vision loss in one eye and that he has no history of eye diseases. The eye care specialist examines the eye and suspects that the symptoms might be due to Ischemic Optic Neuropathy. So, he orders an OCT scan of the affected eye.
The scan supports the diagnosis and shows that the optic nerve head is swollen. So, the specialist documents the imaging results and his diagnosis along with other details in a comprehensive report.
Here, the billing department can use CPT code 92133 to bill the scan.
Applicable Modifiers for CPT Code 92133
The following are commonly used modifiers with CPT code 92133:
| Modifier | Short Description | Usage |
|---|---|---|
| 26 | Professional Component | Used when billing only for the physician’s interpretation and report of the procedure. |
| TC | Technical Component | Used when billing only for the technical aspects of the procedure (equipment, actual imaging, technician, supplies, etc.) |
| LT | Left Side | Use this modifier when only the left eye is imaged. |
| RT | Right Side | Use RT when only the right eye is imaged. |
Note: Don’t use modifier 50 with CPT code 92133 since the code is inherently bilateral.
CPT Code 92133 – Billing & Reimbursement Guidelines
Here are some additional but essential guidelines to follow that will help you avoid claims denials for CPT code 92133:
Understand the Frequency Limits
According to Medicare guidelines, code 92133 cannot be reported more than twice per year. This is because scans exceeding this annual limit will be considered medically unreasonable and unnecessary.
Pay Attention to NCCI Edits & Bundling Rules
CPT code 92133 is bound by several bundling restrictions that billers must watch closely:
- 92133 and 92134 should not be billed on the same day for the same patient encounter.
- 92133 should not be billed on the same day as 92137 under current guidance.
- As per some payer policies, you cannot use code 92133 on the same date as 92227, 92228, 92229, or 92250.
Check the Medicare Reimbursement Rate
The national average reimbursement amount for CPT code 92133 in 2026 is $30.73 for both non-facility and facility settings.
The following is a more detailed breakdown of the cost structure:
- Professional component:
- Facility price: $16.37
- Non-facility price: $16.37
- Technical component:
- Facility price: $14.36
- Non-facility price: $14.36
You can check the exact reimbursement rate for your Medicare Administrative Contractor (MAC) locality via the PFS Lookup Tool.
Wrapping Up
That’s it! We have reached the end of our guide on CPT code 92133. It is a commonly used code to bill an OCT scan of the eyes. The procedure is specifically performed to image the optic nerves.
Note that the code is bilateral in nature, so you don’t have to use modifier 50. Also, 92133 includes both the technical and professional components.
Even with all the guidelines, medical billing is hard. Many practices and in-house billing teams face difficulties with 92133 and other ophthalmology codes. If you are one of them, it is better to let a professional handle your billing. Many companies like MediBillMD offer quality ophthalmology billing services at affordable rates.
