2024 Ophthalmology CPT Code Tip Sheet

Ophthalmology CPT codes play an essential role in your practice’s workflow. When your team has a solid grasp of them, processing payments and upholding regulatory standards is easy. When they don’t, your administrative processes slow and errors can happen.

To ensure your practice can smoothly code with confidence, we’ve compiled a list of the most important ophthalmology CPT codes, including new ones in 2024. Plus, tips on how to optimize your ophthalmology practice’s coding routine can make your team even more efficient.

Ophthalmology CPT Codes 

Ophthalmological services and examinations are assigned unique codes by the American Medical Association to improve billing and administrative workflows. These codes play a crucial role in your practice’s finances. When codes are well-organized and accurately capture services provided, they improve revenue cycle management, leading to faster reimbursements. CPT codes can also help improve the patient experience and clear up questions about payments.

The ophthalmology CPT codes for an eye visit range from 92002–92014. Used for new and returning patients, these codes refer to visits where three or more of the 12 eye visit examinations are completed. Codes are five digits and occasionally include modifiers denoting variations in service. They are grouped into categories for Office Visits, Diagnostic Tests, and Surgical Procedures, as well as the additional Modifiers, such as “-RT” indicating right eye. 

While 92002-92014 are the most used ophthalmology codes, others exist too. For example, Evaluation and Man­agement (E&M) codes are used when a patient – whether a new patient or an established one – attends an exam where a provider either evaluates or manages the patient's health. They begin with 99 and are five digits long (99202-99499). These codes are commonly linked to other diagnosis codes. Key codes to remember include:

• 99221-99223 and 99231-99233: inpatient and observation care services
• 99281 to 99285: services in emergency departments while 
• 99304-99310, 99315, or 99316: services in nursing facilities 
• 99341, 99342, 99344, 99345, or 99347-99350: services performed at a home or place of residence 
• 99242-99245 or 99252-99255: other ophthalmology consultations

Since the American Medical Association retires and adds codes yearly, reviewing code changes should be part of your practice’s annual workflow. 

Eye Code Visit Checklist

Your practice likely uses ophthalmology CPT codes 92002-92014 often. These codes are used for eye visits where an ophthalmologist reviews a patient’s sight and determines if treatment is needed. 

During these visits, your team captures a patient’s history, exams completed, and diagnosis information. For patient history, your practice should note information on the primary complaint, any medical observations, and patient medical history. 

The examinations performed greatly influence the code used. The 12 examination tasks include:

• Anterior chamber
• Conjunctiva
• Cornea
• Dilation
• Extraocular motility
• Gross or confrontational visual fields
• Intraocular pressure
• Lens
• Ocular adnexa
• Optic nerve discs
• Pupil and iris
• Retina and vessels
• Visual acuity

Diagnosis and recommended treatment should also be noted. This can include information on:

• Medication, glasses, or contact lenses prescription
• Arranging for special diagnostic or treatment options
• Recommended consultation
• Recommended lab procedures
• Scheduling follow-up appointments
• Recommended radiology services

2024 Ophthalmology CPT codes

Ophthalmology CPT codes change about once per year. Usually, changes are announced a few months before a new calendar year. These are the new and retired codes in 2024.

Old Codes No Longer Used

In 2024, 49 codes were deleted and 70 codes were revised. None of these changes or removals regard evaluation and management codes, such as the ones listed above. If your practice hasn’t looked into the deleted and revised codes already, delegating this task to a staff member may be beneficial. Reserving time in their schedule to review retired codes could help your practice ensure all codes used are up to date. 

New Code

One new code was introduced in 2024. Code 67516, designates suprachoroidal space injection of pharmacologic agent as a separate procedure.

While not a billing code per se, there were some changes to the Merit-Based Incentive Payment System (MIPS) too. To stay current with MIPs and ophthalmology billing coding changes, it’s best to work with an EHR provider who can help you organize patients’ health records, utilize the correct billing codes, and optimize your workflow to improve your MIPS score. 

At Nextech, for example, our EHR offers streamlined charts that enhance your practice’s workflow and simplify coding, and our practice management software simplifies insurance billing and eliminates administrative burdens. 

For Bay Eye Clinic, investing in Nextech’s PM and EHR also provided a partner who could deliver expert counsel on administrative issues. Their clinic staff could attend quarterly events to inform the rest of the team of any EHR/PM updates, as well as other training opportunities throughout the year. 

Tips for Billing and Coding in OPH

Setting aside a few hours to learn more about ophthalmology billing codes is time well spent. To make your investment more beneficial, here are some tips to keep in mind about billing and medical coding: 

• Understand the relationship between codes and insurance providers: Medical codes can be limited by different insurance providers. To ensure patients receive affordable, relevant treatment, pay attention to which codes are limited by which providers.
• Train your staff: Train staff and providers on what codes mean and coding functions specific to your EHR. To make the latter easier, invest in an ophthalmology EHR with robust training.
• Designate a go-to person: While multiple staff members will have some training on ophthalmology billing codes, designate one person as the go-to expert on coding changes and how to code within your specific EHR.
• Invest in the right partners: Administrative technology updated for the most recent codes is a great option, and it’s even better when the company offers a customer support team that can help you navigate how coding works within their specific software.
• Avoid under and overcoding: Overcoding occurs when ophthalmology billing codes result in payments higher than the cost of provided services. Undercoding is the reverse: the payment amount associated with the billing code is less than the cost of provided services. Neither is ideal for your practice, and your staff should take steps to prevent both.

While your team should be up to date on ophthalmology codes, they don’t bear this burden alone. Choose a partner that offers ophthalmology EHR and practice management software that can generate suggested codes based on what happened in an appointment and experienced customer support to answer any billing questions. 

Nextech’s comprehensive EHR and PM software and expert support team could be a good fit for your practice. Schedule a demo to learn how our solution can optimize your coding process to fuel growth and efficiency.  

Angela Myers is a health and health tech writer with bylines in Forbes and AARP, among others.