Summary & Overview
CPT 92260: Measurement of Retinal Arterial Blood Pressure
CPT code 92260 denotes the measurement of arterial blood pressure in the retina, a diagnostic procedure used in ophthalmology to assess retinal vascular hemodynamics and support evaluation of ocular and systemic vascular conditions. Nationally, the code matters because it defines billing for a specialized diagnostic service that can influence ophthalmic clinical workflows, payer coverage decisions, and reimbursement for retina diagnostic testing.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how 92260 is classified and used clinically, typical sites where the service is delivered, and what to expect in payer coverage patterns. The publication also summarizes available benchmarks and coding context for related retinal diagnostic services, highlights recent policy updates affecting diagnostic ophthalmic codes where applicable, and outlines common billing considerations for facilities and eye care specialists.
This summary is written for a national audience and is intended to orient clinicians, billing staff, and policy stakeholders to the clinical purpose and billing context of CPT code 92260 without providing individualized reimbursement advice.
Billing Code Overview
CPT code 92260 describes the measurement of arterial blood pressure in the retina. This service involves instrumented assessment of retinal arterial pressure to evaluate ocular and systemic vascular status.
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Service type: Diagnostic retinal vascular measurement
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Typical site of service: Ophthalmology clinic or eye specialty diagnostic facility
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a history of systemic hypertension and suspected hypertensive retinopathy is referred to an ophthalmology clinic for assessment of retinal vascular perfusion. The clinician performs measurement of arterial blood pressure in the retina (92260) as part of an outpatient diagnostic evaluation. The typical workflow: review referral and medications, obtain informed consent, instill topical dilation if needed, position the patient at the retinal imaging device, acquire retinal arterial pressure measurements using noninvasive ophthalmodynamometry or equivalent instrumentation, document the measurement values and laterality, interpret findings in the context of systemic blood pressure and retinal examination, and include the result in the ophthalmology visit note. Typical site of service is an ambulatory ophthalmology clinic or outpatient diagnostic imaging center. The patient scenario often includes complaints of vision change, known diabetes or hypertension, or monitoring of previously noted retinal vascular disease.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation/report is billed separate from the technical component |
| TC | Technical component | Use when only the equipment and technician services are billed
| 52 | Reduced services | Use when the procedure is partially reduced or not completed as originally intended
| 53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances
| 76 | Repeat procedure by same physician | Use when the same physician repeats the artery pressure measurement on the same day
| 77 | Repeat procedure by another physician | Use when a different physician repeats the measurement on the same day
| 59 | Distinct procedural service | Use when this measurement is a separate, distinct service from other procedures on the same day
| 79 | Unrelated procedure/service by the same physician during postoperative period | Use when performed during a global period and unrelated to the original surgery
| 22 | Increased procedural services | Use when the service required substantially greater resources or time than usual
| 52 | Reduced services | Use when limited exam or incomplete measurement prevents full service (note: listed once above intentionally; include here only if necessary)
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207W00000X | Ophthalmology | Ophthalmologists commonly perform and interpret retinal arterial pressure measurements |
| 207WH0000X | Vitreoretinal Disease | Retina specialists perform these measurements in complex retinal vascular disease
| 2080P0207X | Family Medicine | Primary care physicians may order the test and occasionally perform bedside retinal assessments
| 207K00000X | Optometry | Optometrists in some states perform retinal diagnostic testing and measurements
| 363L00000X | Diagnostic Radiology | Imaging centers and diagnostic specialists may provide the technical component
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H35.03 | Nonexudative age-related macular degeneration | Retinal arterial pressure may be measured when concurrent vascular compromise or monitoring is indicated |
| H35.0 | Unspecified macular degeneration | Used when retinal vascular assessment contributes to macular disease evaluation
| I10 | Essential (primary) hypertension | Systemic hypertension is directly related to retinal arterial pressure and hypertensive retinopathy assessment
| E11.39 | Type 2 diabetes mellitus with diabetic retinopathy, proliferative or unspecified | Diabetes-associated retinal vascular disease often prompts arterial pressure measurement
| H34.8 | Other retinal vascular occlusions | Measurement can assist in assessing perfusion in retinal vascular occlusive disease
| H44.9 | Disorder of globe, unspecified | Broad code sometimes used when retinal vascular assessment is part of undifferentiated ocular disease
| H35.1 | Background retinopathy and retinal vascular changes | Directly related to retinal vascular pressure assessment and monitoring
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92250 | Fundus photography with interpretation and report | Often performed before or after retinal arterial pressure measurement to document retinal appearance and correlate findings |
| 92134 | Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report (OCT) | Frequently performed alongside to evaluate retinal structure and vascular layers when assessing retinal perfusion
| 92240 | Fluorescein angiography with interpretation and report | Performed when detailed vascular transit and perfusion assessment is required; complements arterial pressure measurement
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient | Typical E/M code used for the clinic visit during which the measurement is ordered and discussed
| 92083 | Visual field examination, extended (e.g., for peripheral field) | May be performed in patients with suspected vascular-related visual field defects