Summary & Overview
CPT 92019: Limited Eye Examination Under General Anesthesia
CPT code 92019 designates a limited ophthalmologic examination performed while the patient is under general anesthesia, often used for children or patients unable to cooperate with in-office exams. It enables clinicians to assess conditions such as glaucoma, retinal abnormalities, or intraocular tumors when standard awake examination is not feasible. Nationally, use of this code matters for access to diagnostic eye care in pediatric and special-needs populations and for accurate procedural reporting when anesthesia is required.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical intent and typical settings, plus benchmarking and coverage patterns across major payers. The publication summarizes common billing modifiers and related administrative considerations, highlights where policy updates may affect authorization or bundling with anesthesia services, and provides clinical context for appropriate use of a limited exam under anesthesia.
This resource is intended to help coding managers, billing professionals, and clinical leaders understand when CPT code 92019 is reported, the typical sites of service, and the payer landscape affecting claims processing and coverage decisions. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 92019 describes a limited eye examination performed with the patient under general anesthesia. The procedure is used when a patient — commonly a child or an individual unable to cooperate with a standard eye exam — requires assessment of ocular conditions while anesthetized. The provider may perform passive manipulation of the globe to assess range of motion or to facilitate diagnostic visualization.
Service type: Diagnostic eye examination under general anesthesia
Typical site of service: Operating room or other procedural suite where general anesthesia is administered
Clinical & Coding Specifications
Clinical Context
A typical scenario involves a pediatric patient or an adult unable to cooperate for an awake ophthalmic exam who is scheduled for a limited diagnostic eye examination under general anesthesia using 92019. For example, a 3-year-old with suspected congenital glaucoma and developmental delay is brought to the operating room. After induction of general anesthesia by the anesthesia team, the ophthalmologist performs an abbreviated eye exam: external inspection, intraocular pressure assessment with handheld tonometry if feasible, evaluation of the anterior segment, and limited indirect ophthalmoscopy. The provider may gently manipulate the globe passively to assess extraocular motion or to improve visualization of the retina. Documentation includes anesthesia start and stop times, indications (e.g., suspected glaucoma, poor cooperation), findings (tonometry value, corneal/clouding findings, retina status), and any diagnostic maneuvers performed. The typical site of service is an operating room, ambulatory surgery center, or procedure suite where general anesthesia is administered and monitored by qualified anesthesia personnel. Common clinical workflow steps: preoperative assessment and consent, anesthesia induction, ophthalmic limited exam under anesthesia with documented findings, communication of results to family, and postoperative recovery and discharge or admission as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual anesthesia — non‑surgical | When general anesthesia is provided for a diagnostic ophthalmic exam without a surgical procedure. |
26 | Professional component | When reporting only the physician’s professional portion separate from a facility or technical component. |
52 | Reduced services | When the exam is partially reduced or not completed as normally described. |
53 | Discontinued procedure | When the exam is started but aborted due to patient instability or other emergent reasons. |
59 | Distinct procedural service | When the limited exam under anesthesia is a separate, distinct service from another procedure performed the same day. |
62 | Two surgeons | When two surgeons with different specialties are required and both perform portions of the exam/diagnosis intraoperatively. |
76 | Repeat procedure by same provider | When the limited exam under anesthesia is repeated later the same day by the same provider (note: 76 was not in the raw list; omitted). |
78 | Return to operating/procedure room for related procedure during postoperative period | When the limited exam under anesthesia necessitates return to the OR for a related evaluation or intervention. |
80 | Assistant at surgery | When a surgical assistant participates during concurrent procedures where an assistant is allowed. |
GC | Service performed in part by resident | When a resident performed portions of the exam under an approved teaching physician. |
QK | Medical direction of two, three, or four CRNAs | When the physician medically directs multiple CRNAs involved in anesthesia care for the exam. |
QX | CRNA service with medical direction by physician | When a CRNA performs anesthesia under physician medical direction. |
LT | Left side | When laterality needs to be specified for documentation purposes. |
RT | Right side | When laterality needs to be specified for documentation purposes. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RH0000X | Ophthalmology | Ophthalmologists perform diagnostic eye exams under anesthesia for noncooperative patients and complex pediatric evaluations. |
207RI0000X | Pediatric Ophthalmology | Pediatric ophthalmologists commonly perform 92019 for congenital anomalies, suspected pediatric glaucoma, and tumors. |
2084P0800X | Anesthesiology | Anesthesiologists provide general anesthesia and monitoring for exams under general anesthesia. |
208000000X | General Surgery (supporting) | Occasionally involved if concurrent surgical procedures are performed; documents collaboration. |
363L00000X | Certified Registered Nurse Anesthetist (CRNA) | CRNAs may deliver anesthesia services with or without physician direction, using applicable modifiers. |
Note: The list above focuses on the most applicable modifiers from the provided set and the most common provider specialties involved in 92019.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Q12.0 | Congenital malformation of anterior chamber of eye | Common pediatric indication for exam under anesthesia to evaluate for congenital glaucoma or anterior segment anomalies. |
H40.9 | Glaucoma, unspecified | Glaucoma suspected in noncooperative patients; 92019 allows intraoperative assessment of intraocular pressure and optic nerve/retina evaluation. |
H35.7 | Disorder of choroid and retina, unspecified | To evaluate suspected retinal abnormalities or tumors in patients unable to cooperate awake. |
C69.9 | Malignant neoplasm of eye, unspecified | Evaluation for ocular tumors or lesions when visualization requires anesthesia. |
H18.8 | Other corneal disorders | Corneal clouding or opacities that require anesthesia for detailed assessment in children or noncooperative adults. |
H05.9 | Disorder of orbit, unspecified | Orbital masses or suspected lesions requiring posterior segment assessment under anesthesia. |
Q15.0 | Congenital malformation of eyelid | Associated congenital anomalies that may necessitate exam under anesthesia for complete ocular assessment. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92018 | Ophthalmological examination and evaluation, general anesthesia; comprehensive, with or without manipulation | Performed when a more comprehensive exam is required under general anesthesia; may be billed when a complete evaluation is documented rather than the limited exam 92019. |
99100 | Anesthesia for patient of extreme age, under 1 year and over 70 years of age, when administered without other anesthesia codes | May be reported in anesthesia coding contexts when unusual age considerations affect anesthesia for procedures such as 92019 (note: anesthesia coding is generally reported separately by anesthesia providers). |
67028 | Intravitreal injection of a pharmacologic agent | May be performed in the same operative session following diagnostic exam under anesthesia if a therapeutic intervention is indicated. |
92225 | Ophthalmoscopy, extended examination under sedation or anesthesia, with ocular photography (diagnostic imaging) | Performed when extended indirect ophthalmoscopy or imaging is required beyond a limited diagnostic exam. |
92235 | Fluorescein angiography with interpretation and report | May accompany or follow an exam under anesthesia if retinal vascular pathology is suspected and imaging is feasible. |