Summary & Overview
CPT 92202: Extended Ophthalmoscopy with Optic Nerve or Macula Drawing
CPT code 92202 represents an extended ophthalmoscopy with drawing and interpretation of the optic nerve or macula. This procedure documents a detailed posterior-segment eye exam performed with an indirect ophthalmoscope and a hand-held indirect lens, accompanied by a clinical drawing and written report. The code is used when a more comprehensive visual documentation of the optic nerve or macula is generated during the encounter.
Nationally, 92202 is relevant for ophthalmology and optometry providers who perform in-office diagnostic examinations that require detailed documentation of posterior-segment findings. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers commonly adjudicate ophthalmic diagnostic services and establish coverage and documentation requirements that affect billing and clinical workflows.
Readers will find a concise overview of what 92202 denotes, the clinical and billing context for its use, and a summary of typical site-of-service expectations. The publication also covers payer coverage patterns and benchmarks where available, relevant policy considerations affecting reimbursement and documentation, and practical notes on coding alignment with related ophthalmic services. Data not available in the input will be identified as such.
Billing Code Overview
CPT code 92202 describes an extended ophthalmoscopy procedure. The provider performs an extended examination of the posterior segment of the eye, typically using an indirect ophthalmoscope with a bright light and a hand‑held indirect lens rather than a one‑piece direct ophthalmoscope. The service includes creation of a drawing of the optic nerve or macula with interpretation and preparation of a written report. Report this code for an extended ophthalmoscopy with optic nerve or macula drawing on one or both eyes.
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Service type: Extended diagnostic ophthalmic examination with documentation and drawing
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Typical site of service: Eye clinic or ophthalmology office setting, procedure performed at the point of care
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with progressive vision changes and suspected optic nerve pathology is evaluated in an ophthalmology clinic. The ophthalmologist performs an extended ophthalmoscopy using an indirect ophthalmoscope to examine the posterior segment, focusing on the optic nerve head and macula. The provider documents detailed findings, creates a drawing of the optic nerve and macula (one or both eyes as indicated), interprets the findings, and writes a formal report. The visit may follow initial history, visual acuity, pupil exam, intraocular pressure measurement, and anterior segment evaluation; ancillary testing such as optical coherence tomography (OCT) or fundus photography may be ordered or performed subsequently. Typical sites of service include an ophthalmology or retina specialist office, an ambulatory surgical center when performed as part of a procedure visit, or an outpatient clinic. Billing uses 92202 for the extended ophthalmoscopy with optic nerve or macula drawing, with appropriate modifier(s) applied when required by payer rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation and report separate from technical component. |