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