Summary & Overview
CPT 2022F: Dilated Retinal Exam for Diabetic Retinopathy
CPT code 2022F designates a dilated retinal examination performed by an ophthalmology or optometry provider for a patient with diabetes who has documented diabetic retinopathy. This code captures a targeted, documented clinical assessment of the retina after pharmacologic dilation, including interpretation and charting of retinal findings. Nationally, accurate use of this code supports quality reporting, clinical monitoring of diabetic eye disease, and appropriate tracking of vision-related complications in diabetes care.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the service, typical sites of care, and the types of documentation that align with the code description. The publication outlines expected benchmarks and reporting use cases, notes common modifiers where available, and highlights how this code fits into diabetic eye care workflows and quality measurement. Data not available in the input is clearly identified where applicable.
Billing Code Overview
CPT code 2022F describes a dilated retinal eye exam performed by an ophthalmology or optometry provider in a patient with diabetes who has evidence of diabetic retinopathy. The provider performs the dilated retinal examination, interprets the retinal findings, and documents the results in the patient’s medical record.
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Service type: Eye exam with dilation and retinal evaluation for diabetic retinopathy
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Typical site of service: Ophthalmology or optometry clinic / outpatient eye care setting
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a 10-year history of type 2 diabetes presents to an ophthalmology clinic for routine diabetic eye surveillance. The patient reports stable vision but has had prior episodes of mild nonproliferative diabetic retinopathy. The ophthalmologist or optometrist performs a comprehensive eye visit including pharmacologic pupillary dilation and a dilated retinal examination. Using slit-lamp biomicroscopy and indirect ophthalmoscopy, the clinician documents the presence and severity of diabetic retinopathy (for example, microaneurysms, dot-blot hemorrhages, hard exudates, macular edema, or new vessels). Findings are interpreted and recorded in the patient’s chart, with a plan for follow-up imaging or treatment as indicated. Typical site of service is an outpatient ophthalmology or optometry clinic; the service type is a dilated retinal eye exam for a diabetic patient with evidence of diabetic retinopathy and formal interpretation and documentation by the ophthalmology or optometry provider.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used / reporting default | Use as the unmodified claim representation when no special circumstances apply |
8P | Professional component modifier for vision/eye services (payer-specific use) | Use when reporting the ophthalmologist/optometrist professional interpretation and documentation component as defined by the payer |
26 | Professional component | Use when reporting only the professional component of a test or service when the technical component is billed separately |
TC | Technical component | Use when billing only the technical component of a test or service (equipment/tech staff) |
25 | Significant, separately identifiable evaluation and management (E/M) service by the same provider on the same day | Use when a distinct E/M visit occurs in addition to the dilated retinal exam |
59 | Distinct procedural service | Use to indicate a separate, distinct procedure performed the same day that is not normally reported together |
GS | Monitored anesthesia care (MAC) service | Use when MAC is provided for ocular procedures that require anesthesia during the same encounter |
PT | Left eye (modifier P and T are hypothetical payer-specific laterality codes) | Use for identifying laterality if required by payer (confirm specific payer modifier semantics before use) |
RT | Right side | Use to indicate the right eye when laterality modifiers are required by the payer |
LT | Left side | Use to indicate the left eye when laterality modifiers are required by the payer |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207W00000X | Ophthalmology | Physicians who perform comprehensive and dilated retinal examinations in diabetic patients |
| 207Y00000X | Optometry | Optometrists licensed to perform dilated retinal exams and document diabetic eye disease |
| 207K00000X | Retina Specialist (Ophthalmology subspecialty) | Subspecialists who interpret advanced diabetic retinopathy findings and manage retinal treatments |
| 208000000X | Primary Care (Family Medicine/Internal Medicine) | Often refer diabetic patients for annual dilated retinal exams; may document referral and review findings |
| 3336C0002X | Endocrinology | Manages diabetes; coordinates screening and follow-up for diabetic retinopathy |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92014 | Ophthalmological services: comprehensive eye exam; established patient, with dilation and retinal evaluation, with initiation or continuation of diagnostic and treatment program | Performed as the comprehensive level exam that may include the dilated retinal exam and documentation for diabetic retinopathy in established patients |
92004 | Comprehensive ophthalmological evaluation and management of a new patient, with initiation of diagnostic and treatment program; intermediate or complex | Use for new patients requiring a comprehensive evaluation that includes dilation and retinal assessment for diabetic retinopathy |
92250 | Fundus photography with interpretation and report | Often performed adjunctively to document retinal findings for diabetic retinopathy and to support imaging documentation in the chart |
92134 | Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve (e.g., OCT) | Commonly used to evaluate macular edema or retinal thickness as part of diabetic retinopathy assessment following dilated exam |
67028 | Intravitreal injection of a pharmacologic agent (separate procedure) | May follow detection of clinically significant macular edema or proliferative disease requiring intravitreal therapy |