Summary & Overview
CPT 92014: Comprehensive Eye Examination for Established Patient
CPT code 92014 represents a comprehensive eye examination performed by an ophthalmologist for an established patient. This code captures a full, face-to-face evaluation when the patient has been seen by the same physician or another physician in the same group or specialty within the prior 36 months. As a commonly billed ophthalmology code, 92014 is central to outpatient eye care workflows and compliance, and it is frequently used in routine and problem-directed follow-up care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication summarizes how 92014 is used across clinical settings, typical sites of service, and the clinical contexts in which a comprehensive established-patient exam is reported. Readers will get concise benchmarks for utilization patterns, a review of relevant documentation expectations tied to the comprehensive exam definition, and notes on common clinical diagnoses that typically accompany this service. The report also addresses billing relationships with adjacent ophthalmology services and highlights considerations for claim accuracy and administrative review.
This national-level overview is intended for clinical managers, coding and billing staff, and policy analysts who need a clear reference for how CPT code 92014 is defined and applied in outpatient ophthalmology practice.
Billing Code Overview
CPT code 92014 describes a comprehensive ophthalmological examination for an established patient. The service is a full eye evaluation performed by an ophthalmologist for a patient who has been seen by the same physician or another physician in the same group or specialty billing under the same group number within the prior 36 months.
Service type: Comprehensive ophthalmology visit (established patient)
Typical site of service: Outpatient ophthalmology clinic or physician office
Clinical & Coding Specifications
Clinical Context
An established patient returns to an ophthalmologist for a comprehensive eye examination billed with 92014. The patient is a 68-year-old with progressive blurred near vision and intermittent glare. The encounter includes history review, medication reconciliation, measurement of visual acuity, intraocular pressure check, slit-lamp anterior segment exam, dilated fundus exam, and refraction as indicated. Relevant diagnoses include H52.4 (presbyopia) and H25.9 (age-related cataract). The clinical workflow begins with intake by clinical staff (vital signs, medication list, visual acuity), preliminary testing (autorefraction, tonometry, optical coherence tomography if available), followed by the physician’s comprehensive evaluation, diagnostic decision-making, and documentation of findings and management (monitoring, glasses prescription, or referral for cataract surgery). Typical follow-up or adjunct procedures (imaging or extended ophthalmoscopy) are ordered based on exam findings. The typical site of service is an outpatient ophthalmology clinic or ambulatory surgical center where an established relationship exists (previous face-to-face visit within 36 months).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day | Use when a separate E/M portion is performed in addition to a procedure on the same date |
26 | Professional component | Use when billing only the physician’s interpretation portion of a service |
TC | Technical component | Use when billing only the facility/technical portion of a test |
52 | Reduced services | Use when the service is partially reduced or not completed |
59 | Distinct procedural service | Use to indicate a separate, distinct ophthalmic procedure or service |
76 | Repeat procedure by same physician | Use when the same service is repeated later the same day |
77 | Repeat procedure by another physician | Use when repeated by a different physician |
78 | Return to OR following initial procedure | Use if patient returns to operating room for related complication (rare for office-based 92014 but included when applicable) |
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the exam or portions are delivered via live telehealth modalities supported by payer |
QX | Ordering/referring physician attests no financial relationship with DME supplier | Use where applicable for ordered durable medical equipment (rare for 92014) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207W00000X | Ophthalmology | Primary specialty performing 92014; includes comprehensive medical eye exams |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H52.4 | Presbyopia | Common refractive cause of near-vision difficulty identified and managed during a comprehensive eye exam 92014 |
H40.9 | Unspecified glaucoma | Increased intraocular pressure or optic nerve concerns detected or monitored during the comprehensive exam; may prompt glaucoma-specific testing |
H25.9 | Unspecified age-related cataract | Lens opacity causing visual symptoms identified on slit-lamp exam; influences management and surgical referral decisions |
H53.9 | Unspecified visual disturbance | Symptom code commonly encountered that prompts a comprehensive evaluation to determine cause |
Z01.00 | Encounter for examination of eyes and vision without abnormal findings | Used when a comprehensive exam documents normal findings for surveillance or routine vision care |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92225 | Extended ophthalmoscopy | Performed when a more detailed dilated fundus exam is needed beyond the standard ophthalmoscopy during a comprehensive exam; may be ordered or performed during the same encounter |