CurrentSelectHealthPolicy 31

Screening visual acuity test (CPT 99173) — Reimbursement/Payment Policy

This reimbursement policy governs coverage and payment for screening visual acuity testing (CPT 99173) across SelectHealth Commercial, Medicare (CMS), and Community Care (Medicaid) plans, specifying when the service is reimbursed or considered included in other services.

Policy Summary

PayerSelectHealth

PolicyScreening visual acuity test (CPT 99173) — Reimbursement/Payment Policy

Policy CodePolicy 31

Change TypeNo material change

Effective DateJan 1, 2002

Next Review Date

Key ActionDo not separately bill CPT 99173 when performed with a Medical E/M, Preventive service, or routine eye exam; it is considered included in those services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

99173Applicable CPT code described

Not separately reimbursedCommercial/CHIP stance

Non-coveredMedicare (CMS)

Non-coveredCommunity Care (Medicaid)

1/1/02Implementation Date

Policy Summary

PayerSelectHealth

PolicyScreening visual acuity test (CPT 99173) — Reimbursement/Payment Policy

Policy CodePolicy 31

Change TypeNo material change

Effective DateJan 1, 2002

Next Review Date

Key ActionDo not separately bill CPT 99173 when performed with a Medical E/M, Preventive service, or routine eye exam; it is considered included in those services.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

CPT 99173 coverage rules

Coverage determinations for screening visual acuity (CPT 99173):

Commercial / CHIP: SelectHealth will not separately reimburse CPT 99173 when performed at the same time as a Medical Evaluation and Management service, a Preventive Medical service, or a routine eye examination; the screening visual acuity test is considered included in the payment for the evaluation. When visual acuity is measured as part of a general ophthalmological service it is considered a component of the more extensive service. When done with a medical E/M service it is diagnostic and not appropriate to report with code 99173.

Medicare (CMS): CPT 99173 is considered a non-covered service under Select Health Medicare.

Community Care (Medicaid): CPT 99173 is considered a non-covered service under Select Health Community Care.

Billing and provider guidance

Billing Rule

Commercial / CHIP — Do not separately bill 99173

Do not separately bill CPT 99173 when performed at the same time as a Medical Evaluation and Management service, a Preventive Medical service, or a routine eye examination; the screening visual acuity test is considered included in the payment for the evaluation and, when performed with an E/M, is diagnostic and not appropriate to report with 99173.

Applies to SelectHealth Commercial plans and CHIP.

Denial Risk

Medicare (CMS) — 99173 non‑covered

CPT 99173 is a non-covered service under Select Health Medicare (CMS); submitters should not expect reimbursement for this code for Medicare product members.

Denial Risk

Medicaid (Community Care) — 99173 non‑covered

CPT 99173 is a non-covered service under Select Health Community Care (Medicaid); claims for this code for Community Care members are not covered.

Definitions and scope

inv-06: Visual acuity test

DefinitionA test that measures ability to see details at near and far distances; typically performed by having the patient read letters of different sizes on an eye chart (e.g., Snellen chart) at 20 feet.

Typical methodsSnellen chart (20 feet) or equivalent standardized eye chart; quantitative bilateral measurement of visual acuity.

Common performersPrimary care providers during routine or preventive exams and eye specialists when focal to the visit.

inv-07: Screening visual acuity test (as screening)

Definition in preventive contextWhen performed as part of an age-appropriate preventive medicine examination, a screening visual acuity test is considered included in the payment for the evaluation and is not separately reimbursable.

Typical settingIncluded when done during routine or preventive medical services (age-appropriate screening).

Billing implicationDo not report CPT 99173 separately when it is performed as part of a preventive medicine exam; it is considered bundled into the evaluation payment.

inv-08: Visual acuity measurement during other services

Component of broader ophthalmologic serviceWhen visual acuity is measured as part of a general ophthalmological service, it is considered a component of the more extensive service and not separately reimbursable.

During Medical E/M servicesIf measured during a medical Evaluation and Management service, the visual acuity measurement is considered diagnostic and it is not appropriate to report CPT 99173 in that context.

Billing implicationDo not separately bill CPT 99173 when visual acuity measurement occurs as part of other covered eye or E/M services; report the more extensive service instead.

OpenPayer

Screening visual acuity test (CPT 99173) — Reimbursement/Payment Policy

Coverage determinations

Relevant codes

Billing and provider guidance

Definitions and scope