Code Reference Library
Complete reference for CPT, HCPCS, ICD-10 codes and modifiers used in eye care billing
Ophthalmological services, medical examination & evaluation, new patient, intermediate
Intermediate ophthalmological exam – new patient. Requires slitlamp and ophthalmoscopy.
Common Modifiers:
Ophthalmological services, medical examination & evaluation, new patient, comprehensive
Comprehensive ophthalmological exam – new patient. Requires slitlamp, ophthalmoscopy, and dilation.
Ophthalmological services, medical examination & evaluation, established patient, intermediate
Intermediate ophthalmological exam – established patient.
Ophthalmological services, medical examination & evaluation, established patient, comprehensive
Comprehensive ophthalmological exam – established patient.
Determination of refractive state
Refraction – not covered by Medicare. Bill to vision plans or collect from patient. May be billed with eye exam codes without modifier.
Office/outpatient visit, new patient, level 2 (straightforward MDM)
Common Modifiers:
Office/outpatient visit, new patient, level 3 (low complexity MDM)
Common Modifiers:
Office/outpatient visit, new patient, level 4 (moderate complexity MDM)
Common Modifiers:
Office/outpatient visit, new patient, level 5 (high complexity MDM)
Common Modifiers:
Office/outpatient visit, established patient, level 1 (minimal problem)
Office/outpatient visit, established patient, level 2 (straightforward MDM)
Common Modifiers:
Office/outpatient visit, established patient, level 3 (low complexity MDM)
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Office/outpatient visit, established patient, level 4 (moderate complexity MDM)
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Office/outpatient visit, established patient, level 5 (high complexity MDM)
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Gonioscopy (separate procedure)
Examination of the anterior chamber angle. Inherently bilateral when both eyes examined. May be billed with eye exam using modifier 59.
Common Modifiers:
Computerized corneal topography, unilateral or bilateral, with interpretation and report
Inherently bilateral. Do not append RT/LT or 50.
Common Modifiers:
Sensorimotor examination with multiple measurements of ocular deviation (e.g., for strabismus analysis) with interpretation and report (separate procedure)
Used for strabismus evaluation. Inherently bilateral.
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Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as SupraThr)
Limited visual field. Medicare: covered for glaucoma/neurological conditions. Not covered for routine exams.
Common Modifiers:
Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program)
Intermediate visual field. Requires medical diagnosis (glaucoma H40.x, neurological, etc.).
Common Modifiers:
Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30°, or quantitative, automated threshold perimetry)
Extended/threshold visual field (Humphrey HVF, Goldmann). Most commonly used for glaucoma management. Medicare covers for glaucoma (H40.x), retinal disease, neurological conditions. Not covered for routine exams.
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Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
Anterior segment OCT (cornea, angle, lens). Inherently bilateral when both eyes imaged. Requires medical necessity diagnosis.
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Scanning computerized ophthalmic diagnostic imaging, posterior segment, optic nerve
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Scanning computerized ophthalmic diagnostic imaging, posterior segment, retina
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Computerized corneal topography, automated; bilateral, with interpretation
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Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease with interpretation and report, unilateral
Extended ophthalmoscopy with retinal drawing, unilateral. Requires retinal diagnosis (detachment, diabetic retinopathy, etc.).
Common Modifiers:
Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease with interpretation and report, bilateral
Extended ophthalmoscopy with retinal drawing, bilateral. Inherently bilateral — do NOT use RT/LT modifiers.
Common Modifiers:
Remote imaging for detection of retinal disease (e.g., retinal detachment, age-related macular degeneration, diabetic retinopathy), unilateral or bilateral, with remote analysis and report
Telehealth retinal screening. Medicare: diabetic patients without ophthalmic coverage. Asynchronous (store-and-forward). Annual frequency limit applies.
Common Modifiers:
Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy, exudative macular degeneration), unilateral or bilateral, with remote analysis and report
Remote monitoring of active retinal disease. Requires established diagnosis of active retinal condition.
Common Modifiers:
Imaging of retina for detection or monitoring of disease; point-of-care autonomous analysis and report, unilateral or bilateral
AI-powered autonomous retinal imaging (e.g., IDx-DR for diabetic retinopathy). Point-of-care analysis. Separate from 92227/92228.
Common Modifiers:
Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral
FA with dye injection. Inherently bilateral when both eyes imaged. Requires retinal/choroidal diagnosis (AMD, diabetic retinopathy, CRVO, etc.). Do NOT use RT/LT when bilateral.
Common Modifiers:
Fundus photography with interpretation and report
Inherently bilateral – do NOT use RT, LT, or modifier 50. For unilateral, use modifier 52.
Common Modifiers:
Ophthalmic ultrasound, diagnostic; B-scan (with or without A-scan)
Common Modifiers:
Ophthalmic ultrasound; anterior segment ultrasound, immersion (water bath), B-scan
Common Modifiers:
Ophthalmic ultrasound; corneal pachymetry, unilateral or bilateral
Once-in-a-lifetime benefit for glaucoma diagnosis/management under Medicare.
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Trabeculoplasty by laser surgery
SLT or ALT. Requires RT or LT modifier.
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Discission of secondary membranous cataract (e.g., secondary cataract, Elschnig pearls) one or more stages
YAG laser posterior capsulotomy. Cannot use routine diagnoses.
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Iridotomy/iridectomy by laser surgery (e.g., for glaucoma)
Cannot use routine diagnoses.
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Extracapsular cataract removal with insertion of intraocular lens prosthesis, complex
Cannot use routine diagnoses. NEVER modifier 50.
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Intracapsular cataract extraction with insertion of intraocular lens prosthesis
Cannot use routine diagnoses.
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Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure)
Standard cataract surgery. Cannot use routine diagnoses. NEVER modifier 50.
Common Modifiers:
Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
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Exchange of intraocular lens
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Extracapsular cataract removal with insertion of intraocular lens prosthesis, complex, with endoscopic cyclophotocoagulation
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Extracapsular cataract removal with insertion of IOL, with endoscopic cyclophotocoagulation
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Extracapsular cataract removal with IOL insertion, complex, with endoscopic cyclophotocoagulation and trabecular ablation
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Extracapsular cataract removal with IOL, with trabecular ablation
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Removal of secondary membranous cataract with corneoscleral section
Cannot use routine diagnoses.
Common Modifiers:
Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery
Common Modifiers:
Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma
Common Modifiers:
Transluminal dilation of aqueous outflow canal; without retention of device or stent
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Transluminal dilation of aqueous outflow canal; with retention of device or stent
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Aqueous shunt to extraocular reservoir, e.g., Molteno, Krupin, Denver-Krupin, Baerveldt, Ahmend valve; without graft
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Aqueous shunt to extraocular reservoir; with graft
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Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach
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Intravitreal injection of a pharmacologic agent (separate procedure)
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Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal
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Vitrectomy, mechanical, pars plana approach
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Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation
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Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation
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Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (e.g., macular pucker)
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Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina
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Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (e.g., choroidal neovascularization)
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Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy)
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Destruction of localized lesion of retina (e.g., macular degeneration), 1 or more sessions; cryotherapy, diathermy
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Destruction of localized lesion of retina; photodynamic therapy, per session
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Treatment of extensive or progressive retinopathy, photocoagulation; preterm infant
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Keratoplasty; anterior lamellar
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Keratoplasty; penetrating (except in aphakia or pseudophakia)
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Keratoplasty; penetrating (in aphakia)
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Keratoplasty; penetrating (in pseudophakia)
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Keratoplasty; endothelial
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Placement of amniotic membrane on the ocular surface; without sutures
0-day global period.
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Blepharoplasty, upper eyelid
Common Modifiers:
Blepharoplasty, upper eyelid; with excessive skin weighting down lid
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Repair of blepharoptosis; frontalis muscle technique with suture or other material (includes obtaining fascia)
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Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling
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Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach
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Repair of blepharoptosis; (tarso) levator resection or advancement, external approach
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Repair of blepharoptosis; superior rectus technique with fascial sling
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Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (e.g., Fasanella-Servat type)
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Removal of embedded foreign body, eyelid
Requires E1–E4 eyelid modifier.
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Strabismus surgery, recession or resection procedure; one horizontal muscle
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Strabismus surgery; two horizontal muscles
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Strabismus surgery; one vertical muscle (excluding superior oblique)
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Strabismus surgery; two or more vertical muscles (excluding superior oblique)
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Chemodenervation of extraocular muscle
Requires strabismus diagnosis (H50.x). Do NOT use modifier 50.
Common Modifiers:
Removal of foreign body, external eye; conjunctival superficial
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Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating
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Removal of foreign body, external eye; corneal, without slit lamp
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Removal of foreign body, external eye; corneal, with slit lamp
Common Modifiers:
Fitting of contact lens for treatment of ocular surface disease
Medical contact lens fitting (therapeutic/bandage). Not for routine vision correction.
Common Modifiers:
Fitting of contact lens for management of keratoconus, initial fitting
Requires keratoconus diagnosis (H18.6x). EyeMed/Spectera require prior auth.
Common Modifiers:
Prescription of optical and physical characteristics of and fitting of contact lens; corneal lens, first pair, bifocal
Prescription of optical and physical characteristics of and fitting of contact lens; corneal lens for aphakia, monocular
Prescription of optical and physical characteristics of and fitting of contact lens; corneal lens for aphakia, binocular
Prescription of optical and physical characteristics of and fitting of contact lens; corneoscleral lens
Common Modifiers:
Prescription of optical and physical characteristics of and fitting of contact lens; corneal lens for aphakia, monocular; by independent technician
Common Modifiers:
Prescription of optical and physical characteristics and fitting of contact lens; corneal lens for aphakia, binocular; by independent technician
Prescription and fitting of contact lens; extended wear
Prescription and fitting of contact lens; corneoscleral lens; by independent technician
Modification of contact lens (separate procedure), with medical supervision of adaptation
Replacement of contact lens
Fitting of spectacle prosthesis following enucleation; monocular
Fitting of spectacle prosthesis following enucleation; binocular
Fitting of spectacle prosthesis following enucleation; binocular; with preparation of custom artificial eye
Fitting of spectacle prosthesis for aphakia; monocular
Fitting of spectacle prosthesis for aphakia; multifocal
Fitting of spectacle mounted low vision aid; single element system
Fitting of spectacle mounted low vision aid; telescopic or other compound lens system
Prosthesis service for aphakia; temporary (disposable or extended wear lens) fitting, prescription, and dispensing
Repair and refitting of spectacle, except for aphakia
Repair and refitting of spectacle for aphakia
Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (e.g., for blepharospasm, hemifacial spasm)
Medical necessity diagnosis required (G24.5 blepharospasm, G51.3 hemifacial spasm). NOT for cosmetic use.
Common Modifiers:
Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral
For bilateral treatment (e.g., chronic migraine, cervical dystonia). NOT for cosmetic use.
Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
Add-on code only. Cannot be billed alone.
Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
Add-on code only.
Vectored thermal pulsation treatment, bilateral
Category III code (C-status). Covered by Novitas and First Coast MAC. 0-day global period. Obtain ABN if coverage uncertain.
Common Modifiers:
Evacuation of meibomian glands, using heat and pressure therapies, bilateral
Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), thoracic; single level
Evacuation of meibomian glands, using heat and pressure therapies, bilateral; with conjunctival expression
Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity
TearLab osmolarity test. Inherently bilateral – do NOT use RT/LT. Practice must have CLIA certificate of waiver. Bill with QW modifier.
Common Modifiers:
Closure of lacrimal punctum; by plug, each
Bill per punctum. Use E1–E4 to specify exact location.
Common Modifiers:
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services (add-on code)
Medicare add-on code effective 1/1/2024. For ongoing longitudinal care of complex conditions. Average reimbursement ~$16.
Glaucoma screening for high-risk patient furnished by an optometrist or ophthalmologist
Glaucoma screening for high-risk patient furnished by a health care professional other than optometrist or ophthalmologist
Administration of standardized, evidence-based Social Determinants of Health (SDOH) risk assessment tool
Wound closure utilizing tissue adhesive(s) only
Unlisted ophthalmological service or procedure
Use when no other CPT code accurately describes the service. Requires special report/letter of medical necessity. Claims with unlisted codes require manual review and are typically paid based on comparable procedures.