Eye Exam CPT Codes (CPT 920xx)

“Many Medicare administrative contractors (MACs) publish policies for General Ophthalmological Services that contain a list of acceptable diagnoses.  All ocular diseases and many systemic diseases which affect the eyes are contained in these policies.”

This FAQ addresses the following:

  1. Are the eye codes different from evaluation and management (E/M) codes?
  2. Who may use the eye codes?
  3. Which diagnosis codes may be used?
  4. May a provider elect to use eye codes exclusively and not submit claims with E/M codes?
  5. What are the requirements of an intermediate eye exam?
  6. What are the requirements of a comprehensive eye exam in the context of the eye codes?
  7. What is meant by the phrase “initiation of diagnostic and management programs”?
  8. What is meant by “general medical observation”?
  9. To comply with CPT requirements, what must be documented for the medical history is an eye code is used?
  10. What is the utilization of eye codes in comparison with E/M codes?

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