Eye Care Coding Reference
CPT 92014 established patient eye exam.
What a comprehensive eye exam for an established patient includes, how it differs from 92012 and 99214, the 3-year new patient rule, billing refraction on the same day and how Medicare and vision plans treat routine exams. Last reviewed October 2026.
In one paragraph
The comprehensive exam for returning patients.
CPT 92014 is the comprehensive eye exam for an established patient, meaning someone seen by the same doctor or a same-specialty doctor in the same group within the past 3 years. It is a general evaluation of the whole visual system that starts or continues a diagnostic or treatment plan, and it can be completed over more than one visit. Refraction is not part of the code and is reported separately with 92015, which Medicare does not cover. The intermediate version is 92012, the new patient version is 92004, and an E/M code such as 99214 is an alternative when medical decision making drives the visit. Descriptions on this page are Vision Rescue summaries, not the official CPT descriptor.
92014 at a glance
- Patient type: established, seen within 3 years
- New patient version: 92004
- Intermediate version: 92012
- Refraction: not included, reported as 92015
- Dilation: performed when indicated, not a fixed rule
- Same day as an E/M visit: report one or the other
What a comprehensive exam includes.
CPT describes the comprehensive eye exam as a general evaluation of the complete visual system that always includes starting or continuing a diagnostic or treatment program. Eye codes are not leveled by history and decision-making points the way E/M codes are, so auditors look for these elements instead.
Exam elements on the AAO checklist
- Chief complaint, history and general medical observation
- Visual acuity and gross or confrontation visual fields
- Extraocular motility, pupils and iris
- Adnexa, conjunctiva, cornea, anterior chamber and lens
- Intraocular pressure
- Optic nerve, retina and vessels
A diagnostic or treatment program
- Prescribing medication, glasses or contact lenses
- Ordering tests, imaging or lab work
- Referral or consultation
- Recommending or scheduling a procedure or surgery
- Scheduling follow-up care
The AAO fact sheet lists 12 exam elements for the comprehensive codes and advises documenting the reason when age or trauma keeps an element from being done. Dilation is done when medically necessary. The AOA notes that CPT says these exams often include dilation, which does not make it mandatory, but some payers require it for certain patients, such as those with diabetes. Document why the pupils were not dilated.
92012 or 92014.
Both codes are for established patients. The difference is the scope of the exam.
| Feature | 92012 intermediate | 92014 comprehensive |
|---|---|---|
| Scope | Evaluation of a new or existing problem, with a limited exam | Evaluation of the complete visual system |
| Exam elements | Fewer than the full set; AAO guidance points to at least 3 | The full set of elements on the AAO checklist |
| Diagnostic or treatment program | Started or continued as needed | Always started or continued |
| Visits | One encounter | Can span one or more visits |
| Typical fit | Focused follow-up, such as checking a stable condition | Full annual exam or full workup of a complaint |
The code follows what the exam documented, not the reason the visit was scheduled. A focused recheck that does not evaluate the whole visual system fits the intermediate description.
New or established patient.
Medicare and most payers use the 3-year rule. A patient is new only if they have had no face-to-face professional service from the doctor, or another doctor of the same specialty in the same group, in the past 3 years.
| Patient | Intermediate | Comprehensive |
|---|---|---|
| New: no visit with the doctor or same-specialty group in 3 years | 92002 | 92004 |
| Established: seen within 3 years | 92012 | 92014 |
- Medicare claims systems recognize ophthalmology and optometry as separate specialties, not subspecialties
- A doctor who joins a practice and sees a colleague's patients is seeing established patients
- Patients who follow a doctor to a new practice generally stay established with that doctor
- CMS recovery auditors review new patient eye codes billed for patients seen within 3 years
Some commercial plans treat optometry and ophthalmology in the same group as one specialty. Check the payer's definition before billing a new patient code for a patient seen by the other specialty in your group.
92014 or 99214.
Eye doctors can report either eye codes or E/M office visit codes. The choice follows the documentation and the payer's rules.
| Point | 92014 eye code | 99214 E/M code |
|---|---|---|
| How the level is set | By the scope of the exam, not by complexity | By medical decision making or total time |
| What drives the visit | A full eye exam | The problems addressed, data reviewed and risk |
| Same day as the other | Not reported with an E/M visit | Includes the general eye exam |
| Payer limits | Some plans cap eye codes per year or tie them to routine benefits | Some plans route specialist visits through E/M |
| 2026 Medicare payment | Exempt from the efficiency adjustment | Exempt from the efficiency adjustment |
The 2026 Medicare NCCI policy manual says general ophthalmological services are not reported separately on the same date as an E/M visit, because the E/M service includes them. Coding educators advise choosing by documentation and payer policy first, never by fee schedule alone.
Refraction and same-day tests.
Refraction has had its own code since 1993 and is not part of 92014. Special eye tests on the same day are separate services.
Refraction with 92014
- 92015 can be reported on the same claim as 92014
- Medicare does not cover refraction, by statute, for any reason
- Medicare does not bundle refraction into the exam
- Many vision plans include refraction in the exam payment
- The patient can be asked to pay for a Medicare-excluded refraction
Tests and procedures the same day
- Special services such as gonioscopy, imaging and visual fields are separately identifiable
- 92250 photos and OCT 92133 or 92134 are generally mutually exclusive, with limited exceptions using modifier 59 or XU
- With a procedure in the 65091-68899 range, a separately identifiable exam carries modifier 25
- Most other 92xxx services need no modifier with the exam
Routine exams, vision plans and medical insurance.
There is no CPT code reserved for a routine exam. Payers decide whether a visit is routine or medical from the diagnosis, the reason for the visit and the patient's benefits.
Original Medicare
- Excludes exams for prescribing or changing glasses or contacts
- Covers exams tied to a symptom, complaint or eye disease
- Covers a yearly diabetic eye exam
- Covers glaucoma screening every 12 months for high-risk patients
- Does not accept the routine exam codes S0620 and S0621
Vision and commercial plans
- Many vision plans pay a routine exam that includes refraction
- Some plans use S0620 or S0621 for routine exams
- Routine benefits are often limited to one exam every 12 or 24 months
- Some Medicare Advantage plans add a routine exam benefit
- Payers may deny 92014 billed with only a routine or refractive diagnosis
Medicare pays for medically necessary exams based on the record. Commercial plans may apply their own frequency edits to eye codes. Check each plan's published policy.
The code itself did not change. Medicare's 2026 fee schedule applied a 2.5 percent efficiency adjustment to many non-time-based services, but eye exam codes and E/M visits were exempt, and office visit payments rose slightly for the year.
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Questions about CPT 92014
What is CPT code 92014?
It is the code for a comprehensive eye exam for an established patient. The exam evaluates the whole visual system and starts or continues a diagnostic or treatment plan, and it can be completed over more than one visit.
What is the difference between 92012 and 92014?
Both are for established patients. 92014 is a comprehensive exam of the complete visual system. 92012 is an intermediate exam focused on a new or existing problem with a more limited set of exam elements.
Can 92014 and 92015 be billed together?
Yes. Refraction is not part of 92014 and is reported separately with 92015. Medicare does not cover refraction, so the patient or a vision plan usually pays for it, and many vision plans include it in the exam payment.
What is the difference between 92014 and 99214?
92014 is an eye code defined by the scope of the exam. 99214 is an E/M code leveled by medical decision making or time. Under Medicare's NCCI policy they are not both reported for the same visit, so the documentation and the payer's rules decide which one fits.
Does 92014 require dilation?
Not in every case. The AAO says to dilate when medically necessary and to document why when dilation is not done. Some payers require dilation for certain patients, such as those with diabetes.
What are the requirements for 92014?
An established patient, a history and general medical observation, the full set of exam elements on the AAO checklist, and the start or continuation of a diagnostic or treatment plan, such as a prescription, tests or follow-up.
What is the CPT code for a routine eye exam?
CPT has no separate routine exam code. Many vision and commercial plans use the eye exam codes or HCPCS S0620 and S0621 for routine exams, while Original Medicare does not cover exams done only to prescribe glasses or contacts.
Sources
AAO EyeNet Savvy Coder fact sheet for the comprehensive eye visit codes; AOA billing and coding guidance on dilation and same-day procedures; Medicare NCCI Policy Manual, Chapter 11, 2026; Medicare Claims Processing Manual, Chapter 12, section 30.6.7; CMS Recovery Audit issue 0039 on new patient ophthalmology codes; Medicare Benefit Policy Manual, Chapter 16, section 90; Ophthalmology Management coding columns on new patients and refraction; Review of Optometry coding column; Retina Today 2026 coding supplement; CMS CY 2026 Physician Fee Schedule final rule fact sheet; AOA statement on the 2026 fee schedule; Medicare.gov coverage pages for glaucoma tests and diabetic eye exams; Blue Cross Blue Shield of Rhode Island ophthalmology exam policy; Review of Ophthalmology 2026 coding update.
Notes and disclosures
CPT is a registered trademark of the American Medical Association. Descriptions here are Vision Rescue summaries, not official CPT descriptors. This page is general information for eye care professionals and billing staff, not legal, billing or coding advice. Payer rules vary; verify codes, modifiers and coverage with the current official code sets, your Medicare contractor and the patient's plan. Questions: providers@visionrescue.com or 1-855-692-8024.
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In-office Rx, take-home products and patient follow-through for optometry and ophthalmology practices.