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    v1.0.28
    OpenPayerBilling CodesDiagnostic/Screening Processes or ResultsCPT cpt-3072f-no-evidence-of-retinopathy-low-risk
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    CPT 3072F: No Evidence of Retinopathy / Low Risk of Retinopathy

    CPT code 3072F indicates that the provider documents no evidence of diabetic retinopathy or indicates a low risk of retinopathy based on any previous examination within the prior 12 months; this reflects an eye health assessment related to diabetes management, typically reported for outpatient ophthalmology or optometry visits and does not require an automated result to be reported.

    For related coverage guidance, see recent payer policy updates: Gamma-glutamyl Transferase (GGT) Testing in Adults, Drug Screen Testing - Professional, Venous and Arterial Thrombosis Risk Testing.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with diabetes mellitus undergoing routine ophthalmic surveillance for diabetic retinopathy. The patient presents to an ophthalmology or optometry clinic for an annual eye exam focused on retinal evaluation. Prior records document a dilated fundus examination or retinal imaging within the past 12 months showing either no diabetic retinopathy or only features indicating low risk of retinopathy progression. The clinician performs a focused retinal assessment during the visit, which may include slit-lamp biomicroscopy with a fundus lens, indirect ophthalmoscopy, and review of prior imaging reports. If the current examination corroborates the absence of retinopathy or confirms low risk compared with the prior exam within 12 months, the provider documents that there is no evidence of retinopathy or that risk remains low and reports 3072F to indicate this finding for quality reporting purposes. Typical sites of service include outpatient ophthalmology clinics, optometry offices, and ambulatory care centers. Common patient workflow steps: review prior exam/imaging, patient interview and visual acuity check, dilation if indicated, retinal exam, documentation referencing the prior 12-month examination, and coding of 3072F when criteria are met.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    92002Ophthalmological services; new patient, intermediate or initial comprehensive eye service, typically without dilationMay be performed as the initial E/M component when a new patient presents for diabetic eye evaluation prior to retinal exam and documentation of 3072F
    92004Ophthalmological services; new patient, comprehensive, with dilationUsed when a comprehensive dilated eye exam is performed for a new patient and retinal status is assessed for reporting 3072F
    92012Ophthalmological services; established patient, intermediate, without dilationMay be used for established patients receiving problem-focused or intermediate eye care when retinal assessment documents no retinopathy
    92014Ophthalmological services; established patient, comprehensive, with dilationCommonly used for annual dilated diabetic eye exams where 3072F is reported if no retinopathy is present
    92250Fundus photography with interpretation and reportPerformed when photographic documentation is obtained; comparison to prior imaging supports reporting 3072F
    92134Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral (OCT)OCT may be used to document retinal status; comparison to prior studies within 12 months may support 3072F reporting

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    P3Modifier P3 denotes that the anesthesia patient has severe systemic disease (ASA III). It applies only to anesthesia CPT codes (00100–01999) and must be appended by the anesthesia provider with…- Applies only to anesthesia procedure codes (CPT 00100–01999) and should be appended by the anesthesia provider when the patient meets the definition of "severe systemic disease" (CPT/AAPC P3;…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207W00000XOphthalmology PhysicianAn ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically train…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    320600000XIntellectual and/or Developmental Disabilities Residential Treatment FacilityA residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intelle…
    261QD1600XDevelopmental Disabilities Clinic/CenterAn entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling …
    207QS0010XSports Medicine (Family Medicine) PhysicianA family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of hea…
    1835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistPharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescrip…

    Related Payer Policy Updates

    Specialty: Laboratory/Pathology1 / 3

    8 rows

    PolicyPayerEffective Date
    Gamma-glutamyl Transferase (GGT) Testing in AdultsOscar Health2026-10-01
    Drug Screen Testing - ProfessionalBlue Cross Blue Shield - Maine2026-10-01
    Venous and Arterial Thrombosis Risk TestingOscar Health2026-10-01
    Diagnostic Testing Of Iron Homeostasis & MetabolismOscar Health2026-10-01
    Serum Tumor Markers for MalignanciesOscar Health2026-10-01
    Prescription Medication and Illicit Drug Testing in the Outpatient SettingOscar Health2026-10-01
    Micronutrient TestingOscar Health2026-10-01
    Metabolite Markers of Thiopurines TestingOscar Health2026-10-01

    Related Codes

    CPT-3006F-CLINICAL-QUALITY-MEASURE

    CPT 3006F: Respiratory Assessment or Therapy Note

    CPT-3008F-NO-SUMMARY-AVAILABLE

    CPT 3008F: No Summary available

    CPT-3011F-CLINICAL-REPORTING-ELEMENT

    CPT 3011F: Clinical Quality Measure Documentation

    CPT-3014F-SCREENING-MAMMOGRAPHY-ASYMPTOMATIC-WOMEN-40-PLUS

    CPT 3014F: Screening Mammography for Asymptomatic Women 40+

    CPT-3015F-PERFORMANCE-MEASURE

    CPT 3015F: Airway Management/Intubation Assessment

    CPT-3016F-ALCOHOL-USE-SCREENING-ANNUAL

    CPT 3016F: Alcohol Screening for Unhealthy Use in Adults

    CPT-3017F-COLORECTAL-CANCER-SCREENING

    CPT 3017F: Colorectal Cancer Screening

    CPT-3018F-SPECIFIC-CLINICAL-REPORTING-ITEM

    CPT 3018F: Oxygen Therapy Assessment or Documentation

    CPT-3019F-UNSPECIFIED-SERVICE

    CPT 3019F: No Summary Found

    CPT-3020F-NO-SUMMARY-AVAILABLE

    CPT 3020F: Clinical Quality Performance Measure

    Showing 1–10 of 199

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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