Summary & Overview
CPT 99173: Pediatric Visual Acuity Screening
CPT code 99173 denotes a pediatric visual acuity screening using a standard distance chart (for example, a Snellen chart) held 20 feet from the patient to assess both eyes. This brief, office-based assessment helps identify refractive errors, amblyopia risk, or other vision concerns early in childhood; timely detection can affect developmental, educational, and sight-preservation outcomes. Nationally, this screening is commonly performed in pediatric and primary care settings and is relevant to preventive health workflows and pediatric quality measures.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and where 99173 fits into routine pediatric preventive care. The publication also outlines benchmarking and policy-relevant considerations for payers and administrators, including coverage posture variations and typical use cases for office- or school-based screenings. Where input data is missing, the text notes that specific payer policies or utilization benchmarks are not available in the source material.
Billing Code Overview
CPT code 99173 describes a pediatric visual acuity screening in which the provider assesses the eyesight of both eyes by asking the child to read letters of varying sizes on a standard chart (for example, a Snellen chart) held 20 feet from the patient. This procedure evaluates distance visual acuity and is focused on pediatric patients.
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Service type: Visual acuity screening / pediatric eye screening
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Typical site of service: Outpatient clinic, primary care office, pediatric office, or school-based health setting
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 5-year-old child presents to a primary care pediatric clinic for a well-child visit. The nurse rooming the patient performs a visual acuity screening using a standardized distance chart (for example, a Snellen chart) positioned approximately 20 feet from the child. The examiner asks the child to read letters of progressively smaller sizes for each eye, then both eyes together, documenting the smallest line read reliably and whether testing was performed monocularly with occlusion. If the child cannot reliably read letters, age-appropriate symbols or tumbling E chart may be used and documented. Test results are recorded in the medical record and reviewed by the pediatrician; abnormal findings prompt referral to pediatric ophthalmology or optometry. The encounter typically occurs in the outpatient clinic exam room but may also occur in school-based health screenings or community well-child screening events.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same provider on the same day | Use when a separately identifiable office visit/E&M is performed in addition to the screening vision test. |
26 | Professional component |