The U.S. Centers for Disease Control and Prevention (CDC) reports that 11 million Americans over the age of 12 need vision correction. In another report, the CDC found that cataract is the leading cause of blindness in the USA, and around 20.5 million Americans aged 40 and above have cataracts in one or both eyes.
This explains why cataract removal is the most performed eye surgery in the USA, with over 3.7 million people undergoing the procedure each year. If you are looking for the most appropriate ophthalmology CPT code for cataract surgery or other services, you have come to the right place. We have compiled a list of common CPT codes for ophthalmology procedures that will help you streamline medical billing, file clean claims, and collect your rightful reimbursements on time.
Most Used Ophthalmology CPT Codes of 2024
From routine examinations to complex surgeries and fitting eyewear to specialized diagnostic tests, these are the most frequently performed eye care procedures of 2024 and their respective ophthalmology CPT codes.
Ophthalmology CPT Codes List for Evaluation and Examination
The American Academy of Ophthalmology (AAO) recommends that children and adults should get frequent eye examinations, at least once every two years, for early detection of prevalent eye problems like cataracts, glaucoma, refractive errors, diabetic retinopathy, and macular degeneration, which can result in vision loss.
Hence, the first ophthalmology CPT code list you must keep handy is for eye evaluations and examinations. The following are some frequently reported CPT codes for ophthalmology evaluation and management (E/M) visits.
CPT Code Range 92002-92004 – New Patient Visits
Ophthalmology CPT codes 92002 and 92004 are ophthalmological evaluations of a new patient. These codes are reported when a new patient visits the eye center. The provider performs an intermediate (92002) or comprehensive (92004) eye examination and initiates a treatment program during the same visit.
CPT Code Range 92012-92014 – Established Patient Visits
On the other hand, ophthalmology CPT codes 92012 and 92014 are assigned for established patient visits and eye exams. These codes are used when the provider sees a returning/established patient and performs an intermediate level (92012) or comprehensive level (92014) eye examination and modifies, continues, or stops the treatment program based on the results.
It must be noted that in ophthalmology, an established patient is the one the provider, or any other physician in the same group practice, is meeting face-to-face again within 36 months.
Opthalmology CPT Codes for Surgeries
According to Cleveland Clinic, the most performed ophthalmology surgeries are cataract removal (approximately 3.7 million per year), laser refractive procedures (close to 800,000 each year), and corneal transplants (nearly 47,000 annually).
Moreover, the American Academy of Ophthalmology states that 80% of the cataract surgeries performed in the country are for Medicare beneficiaries. Therefore, we must be familiar with the CPT codes for ophthalmology surgeries to submit accurate insurance claims and get timely reimbursements from Medicare, Medicaid, or private insurers.
CPT Code 65750 – Corneal Transplant or Keratoplasty
Opthalmology CPT code 65750 is used when the surgeon performs a corneal transplant or keratoplasty to implant a donor cornea in a patient who is missing a lens because of cataract removal or congenital reasons. It is the most common procedure for corneal tissue transplant and is covered by Medicare.
CPT Code 65820 – Incision on the Anterior Chamber
65820 CPT code for ophthalmology is reported when the provider surgically treats congenital glaucoma in children. The surgeon performs an incision on the limbus (in the anterior chamber of the eye) to improve the drainage of aqueous humor.
CPT Code 66761 – Laser Peripheral Iridotomy (LPI)
Ophthalmology CPT code 66761 specifies that a laser-assisted iridotomy or iridectomy was performed. The surgical procedure treats glaucoma by lowering the intraocular pressure in the anterior and posterior chambers of the eye. During this procedure, the provider uses a laser beam to make a hole in the iris and balance the intraocular pressure, preventing optic nerve damage and gradual vision loss.
CPT Code 66852 – Surgical Removal of Lens Material
The 66852 CPT code indicates the removal of lens material and/or vitreous humor to treat cataracts. The surgeon makes an incision through the pars plana (located at the border of the iris and sclera) for complete cataract extraction and to remove the obstruction in the patient’s vision.
Please note that ophthalmology CPT code 66852 is usually bundled with 67113 and should not be billed to Medicare separately except in certain circumstances.
CPT Code 66984 – Extracapsular Cataract Removal
Code 66984 denotes a complex cataract surgery. This ophthalmology CPT code is used when the provider removes an extracapsular cataract using ultrasonic waves (aspiration) and inserts an artificial/prosthetic lens to replace the natural one. During this procedure, the provider does not use an endoscopic laser probe for ciliary shrinking.
CPT Code 66986 – Intraocular Lens Replacement
Ophthalmologists use code 66986 to inform the insurance payers that surgery was performed to replace an old prosthetic intraocular lens with a new one. The replacement surgery may be required because of complications or discomfort with the previously implanted intraocular lens or the patient’s preference.
Opthalmology CPT Codes for Contact Lens Services
Contact lenses are medical devices prescribed by ophthalmologists for vision correction. The CDC’s data states that around 45 million Americans wear contact lenses to correct refractive errors like farsightedness, nearsightedness, and astigmatism. Hence, ophthalmology CPT codes for contact lens services are also some of the most frequently reported at eye care centers.
CPT Code 92310 – Contact Lens Fitting, Both Eyes, Except Aphakia
The provider reports the CPT code 92310 when soft contact lenses are prescribed and fitted in both eyes, except when there is aphakia (the absence of a natural lens as a result of previous cataract surgery, an injury, or congenital reasons).
CPT Code 92316 – Corneal Contact Lens, Both Eyes, with Aphakia
In the case of aphakia, which is the absence of an eye lens, the provider prescribes corneal contact lenses in both eyes to correct the vision (restoring focus and clarity). However, this ophthalmology CPT code indicates that the provider only prescribed and supervised the fitting of corneal contact lenses, while the procedure was performed by an independent technician.
CPT Code 92317 – Corneoscleral Contact Lens Fitting
Corneoscleral contact lenses are hard and prescribed when the standard (soft) contact lenses cannot treat the condition (e.g., keratoconus and pellucid marginal degeneration). Their larger diameters offer better comfort to patients with irregular corneas, improving their vision.
Ophthalmology CPT code 92317 is reported when the provider orders and supervises the fitting of corneoscleral contact lenses in both eyes. An independent technician completes the lens fitting in the patient’s eye.
CPT Code 92326 – Contact Lens Replacement
Reusable contact lenses can be worn for up to a year without replacement if you take care of them and clean them regularly. Code 92326 is used when the provider orders replacement of contact lenses because of wear and tear, loss of one or both lenses, or because the patient complained of discomfort with the existing lens/lenses.
Opthalmology CPT Codes List for Spectacle Services
Did you know that nearly 64% of America’s adult population, 166.5 million, wear prescription eyeglasses? And the percentage increases when we zoom in on the Medicare beneficiaries. According to a study, around 92.4% of Medicare plan holders aged 65 and above wear prescription glasses. Therefore, being familiar with the most used ophthalmology CPT codes for spectacle services is a must.
CPT Code 92340 – Fitting of Monofocal Eyeglasses
This ophthalmology CPT code is reported when the patient needs vision correction for only one eye. The provider prescribes mono-focal eyeglasses (spectacles with single prescription strength) to improve far or nearsightedness.
CPT Code 92354 – Fitting of Magnifying Lens on Eyeglasses
Some patients require special eyeglasses to restrict their vision to a single focal point, especially during activities like reading, stitching, or crafting. In that case, the provider fits a magnifying glass on the spectacles to enhance the patient’s near vision, and code 92354 denotes that.
CPT Code 92371 – Prosthesis for Aphakia (Eyeglass Repairs or Adjustments)
Patients with aphakia (missing eye lens/lenses) are prescribed eyeglasses for vision correction. Ophthalmology CPT code 92371 indicates that the provider adjusted or repaired the eyeglasses in a patient with aphakia to improve the vision.
Opthalmology CPT Codes for Diagnostic Procedures
Specialized opthalmological diagnostic procedures detect eye diseases and conditions, helping the provider recommend the most suitable treatment program for vision restoration or correction. The following CPT codes for ophthalmology diagnostic procedures cover photography, anomaloscopy, and oculography.
CPT Code 92270 – Electro–Oculography for Eye Movement
Code 92270 is used when the provider performs electro-oculography to assess the patient’s eye movement. It must be noted that weakened extraocular muscles cause rapid or uncontrolled eye movement, resulting in double vision.
In this procedure, the provider places electrodes near the eye to measure the electrical potential and evaluate the eye movement. He also interprets the results and prepares a report in the same session.
CPT Code 92283 – Nagel Anomaloscopy for Color Blindness
Around 12 million Americans, or 3.7% of the U.S. population, are color blind. The absence of photopigments in cones (inside the eye) causes color deficiency or color blindness, affecting the person’s ability to see certain colors, such as red and green.
To report this ophthalmology CPT code, the provider must use a Nagel anomaloscope (an optical instrument that uses long wavelengths of yellow-green light) to decide if the patient has red-green color blindness. The patient adjusts the Nagel anomaloscope to match a predetermined ratio of red to green light, highlighting his ability/inability to see red or green colors.
CPT Code 92287 – Special Anterior Segment Photography
This ophthalmology CPT code indicates that the provider used an imaging technique, special anterior segment photography, to take photographs of the front of the eye, including parts like the iris, lens, and cornea. It helps the provider detect abnormalities in the vasculature of the iris. The provider usually orders this test when he wants to check for neovascularization of neoplasms in the anterior segment of the eye.
Bottom Line
The medical claim denial rate in ophthalmology is higher than the average denial rate of all specialties combined. Becker’s ASC found that the median denial rate for ophthalmology practices nationwide was 13%, whereas the average claim denial rate in the healthcare industry is between 5% and 10%. Unfortunately, most of these denials are triggered due to coding errors.
So, if you use our ophthalmology CPT code list to master coding, you can reduce your denial rate and collect the dollars you deserve. But we understand that it is easier said than done. CPT coding and modifier usage to the highest degree of specificity is an intricate and challenging process. However, you can get specialized and standalone CPT coding for your practice for as low as 1% of your monthly collections when you invest in professional ophthalmology billing services offered by a reliable company like MediBill MD.
