Summary & Overview
CPT 95919: Quantitative Pupillary Light Reflex Measurement
CPT code 95919 describes a device-based, quantitative measurement of pupil response to light with physician or qualified healthcare professional interpretation and a written report. This diagnostic service captures objective pupillary light reflex data that can inform neurologic and ophthalmic assessment, concussion evaluation, and monitoring of conditions that affect autonomic or cranial nerve function. Nationally, this code matters for standardizing reporting of pupillometry results and enabling reimbursement for interpreted diagnostic testing outside of routine physical examination.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, common modifiers associated with billing, and where available, benchmark considerations for coverage and billing practice. The publication summarizes what providers bill for when performing device-driven pupillary measurements, how the service is characterized in claims, and the documentation elements typically expected for interpretation and reporting. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 95919 describes a service in which a provider uses a device to obtain a quantitative measurement of pupil reactivity to light. A physician or other qualified healthcare professional provides an interpretation and written report of the findings.
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Service type: Diagnostic measurement of pupillary light reflex using a device with provider interpretation and reporting.
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Typical site of service: Outpatient clinic, ophthalmology or neurology office, hospital outpatient department, or other ambulatory care settings where diagnostic neuro-ophthalmic testing is performed.
Clinical & Coding Specifications
Clinical Context
A 55-year-old patient presents to an ophthalmology clinic with complaints of sudden onset blurred vision and light sensitivity after head trauma. The clinician performs a quantitative pupillometry test using a handheld infrared pupillometer to measure pupil size, reactivity, latency, and constriction velocity. A physician or qualified health professional documents the measurement findings, interprets the pupillary metrics (including asymmetry or afferent pupillary defect), and generates a formal report that becomes part of the medical record. Typical workflow: check vital signs and history, perform standard ocular exam, obtain pupillometry using the device, record values in the chart, clinician reviews tracings and numeric results, documents interpretation and clinical implications (for example, signs of elevated intracranial pressure, optic nerve dysfunction, or pharmacologic blockade), and communicates results to the treating team. Typical sites of service include outpatient ophthalmology/neurology clinics, emergency departments, and inpatient hospital units where neurologic monitoring is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation/report is billed separately from the technical device component |
TC |