Eye Care Coding Reference
CPT 92134 OCT of the retina.
What the code covers, why it is billed once for both eyes, how it relates to 92133, 92137 and fundus photography, the Medicare contractor LCDs, how often scans are expected and what the interpretation and report should show. Last reviewed October 2026.
In one paragraph
The retinal OCT code.
CPT 92134 covers computerized scanning imaging of the posterior segment focused on the retina, most often optical coherence tomography (OCT) of the macula, with the doctor's interpretation and report. The code covers one or both eyes, so it is reported once per encounter. It cannot be reported with 92133 (optic nerve OCT) or 92137 (OCT with angiography) at the same encounter, and Medicare treats it as generally mutually exclusive with fundus photography (92250). Medicare contractor LCDs typically expect no more than one scan every two months for stable retinal disease and up to one a month during active treatment. Descriptions on this page are Vision Rescue summaries, not the official CPT descriptor.
92134 at a glance
- Unilateral or bilateral: one unit per encounter
- Components: professional (26) and technical (TC)
- Not reported with 92133 or 92137 at the same encounter
- With 92250: generally mutually exclusive under NCCI
- Typical LCD frequency: every 2 months, monthly in active treatment
- Common diagnoses: AMD, diabetic macular edema, vein occlusion
What 92134 covers.
The code describes a quantitative scan of the retina, read and reported by the doctor. The image, the computer analysis and the written interpretation are all part of one service.
Part of the service
- Acquiring the retinal scan, in one or both eyes
- Computer analysis, such as thickness maps and comparison to prior scans
- The doctor's interpretation and a signed written report
- Storage of the data for future comparison
Professional and technical parts
| Modifier | Meaning |
|---|---|
| None (global) | The same practice performs the scan and interprets it |
| 26 | Professional component only: the interpretation and report |
| TC | Technical component only: the equipment, staff and scan |
Medicare contractor billing articles list the professional component as payable in hospital settings and the global and technical components in the office. Diagnostic tests like this one are performed under general supervision.
One or both eyes, one unit.
The descriptor for 92134 includes both unilateral and bilateral testing. Medicare pays the same amount whether one eye or both are scanned.
- 92134 is reported once per encounter, without modifier 50
- Eye modifiers are not needed to describe a bilateral scan; some payers have their own rules for a one-eye scan
- Medicare contractor LCDs ask that the record show medical need for each eye when both are scanned
- A scan of both eyes does not turn into two units of service
Same-day billing with other imaging.
Most questions about 92134 are about which tests can be paid on the same day. These are the relationships in CPT guidance and Medicare's NCCI edits.
| Same encounter as 92134 | Rule | Source |
|---|---|---|
| 92133 optic nerve OCT | Not reported together. The NCCI edit does not allow a modifier to bypass it, even with two diagnoses. | CPT guidance; NCCI edit in place since 2011 |
| 92137 retina OCT with angiography | Not reported together. 92137 already includes the structural retina scan. | CPT guidance since January 2025 |
| 92250 fundus photography | Generally mutually exclusive. Both are paid only when each is medically necessary for the same eye, with modifier 59 or XU on 92250. | NCCI Policy Manual 2026, Chapter 11 |
| 92201 or 92202 extended ophthalmoscopy | Medicare contractor LCDs list extended ophthalmoscopy among tests that would generally not be necessary with a scan on the same day. Documentation must justify both. | MAC SCODI LCDs |
| 92227 to 92229 remote retinal imaging | Paired with 92134 in NCCI edits. | NCCI edit tables |
| 92235, 92240, 92242 dye angiography | Separate tests. Each needs its own medical necessity. | CPT and NCCI |
Medicare's 2026 NCCI manual says fundus photography and scanning imaging are generally mutually exclusive because a doctor usually uses one technique or the other to evaluate the fundus. The posterior segment of one eye is treated as a single anatomic site, so the modifier is meant for a limited set of conditions where both tests are needed. Check the current NCCI tables for modifier indicators before relying on any pair.
Medicare LCDs and covered diagnoses.
Several Medicare contractors publish a local coverage determination titled Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI). The covered diagnosis codes sit in each LCD's billing and coding article.
| Contractor | LCD | Billing article |
|---|---|---|
| First Coast Service Options (JN) | L33751 | Listed in the LCD |
| Novitas Solutions (JH, JL) | L35038 | A57600 |
| CGS Administrators (J15) | L34061 | A56692 |
| WPS (J5, J8) | L34760 | A56916 |
Kinds of diagnoses on the 92134 lists
- Diabetic retinopathy, with or without macular edema
- Age-related macular degeneration, wet and dry
- Retinal vein and artery occlusions
- Macular hole, epiretinal membrane and other macular conditions
- Retinal detachment, breaks and retinoschisis
- Chorioretinal inflammation and some ocular tumors
- Monitoring for retinal toxicity from hydroxychloroquine or chloroquine
Not covered
- Screening a patient without signs or symptoms
- Testing that only confirms a diagnosis already established
- A diagnosis code on the list does not by itself prove medical necessity
Some contractors do not publish a SCODI LCD. In those regions, coverage follows Medicare's general reasonable and necessary standard. Search the Medicare Coverage Database for your state to find the current version.
How often 92134 is expected.
The SCODI LCDs listed above describe similar utilization expectations for the retina scan.
Monthly scans are described for active treatment such as intravitreal injections for wet AMD, diabetic macular edema or vein occlusion, and for conditions like macular hole or traction detachment. Hydroxychloroquine and chloroquine monitoring follows a baseline and then yearly testing, starting sooner for higher-risk patients. Scans above these expectations need a clear reason in the record.
The interpretation and report.
The interpretation is part of the code. A scan with no report is an incomplete service, and missing reports are a common reason for recoupment.
- A dated order with the clinical reason for the test
- Which eye or eyes were scanned and the scan quality or reliability
- Findings, such as central thickness, fluid or membrane
- Comparison with prior scans when available
- The diagnosis and how the result affects management
- The interpreting doctor's signature and date
Medicare contractor LCDs also expect the record to show the reason for each eye when both are scanned, and the reason for any second imaging test on the same day.
The code itself did not change for 2026. Its wording was revised in 2025, when 92137 was added for OCT with angiography and CPT guidance began barring 92133, 92134 and 92137 at the same encounter. Payment for the posterior segment OCT codes was reduced in 2025. Medicare's 2026 fee schedule applied an efficiency adjustment to the work value of most non-time-based services, which may include diagnostic tests; check the 2026 fee schedule for your locality.
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Questions about CPT 92134
What is CPT code 92134?
It is the code for computerized scanning imaging of the retina, usually OCT of the macula, including the doctor's interpretation and report. It covers one or both eyes.
Is 92134 a bilateral code?
The code covers one or both eyes and is reported once per encounter. Modifier 50 is not used. Medicare contractors expect the record to show the reason for scanning each eye.
Can 92133 and 92134 be billed together?
No. CPT guidance and Medicare's NCCI edit do not allow both at the same encounter, even with separate diagnoses. The NCCI edit does not accept a bypass modifier.
Can 92134 and 92250 be billed together?
Medicare treats them as generally mutually exclusive. Both are payable only when each is medically necessary for the same eye, with modifier 59 or XU on 92250 and documentation of why each was needed.
How often can 92134 be billed?
Medicare contractor LCDs typically expect no more than one scan every two months for non-active retinal disease and up to one a month during active treatment such as injections. Check your contractor's LCD.
What diagnosis codes are covered for 92134?
The lists sit in each contractor's SCODI billing article and include diabetic retinopathy, macular degeneration, vein occlusion, macular hole, retinal detachment and hydroxychloroquine monitoring, among others.
What is the difference between 92134 and 92137?
92137 is retinal OCT that also includes OCT angiography. It took effect in 2025 and is not reported with 92134 or 92133 at the same encounter.
Sources
Medicare NCCI Policy Manual, Chapter 11, revised January 1, 2026; First Coast LCD L33751; Novitas LCD L35038 and article A57600; CGS LCD L34061 and article A56692; WPS LCD L34760 and article A56916; AAO coding guidance on 92133 and 92134; ASRS retina coding update, 2025; Retina Today, OCT: What to Know for 2025; Retina Specialist coding column on OCT and fundus photography; Review of Ophthalmology Coding and Reimbursement 2026 Update; CMS ICD-10-CM FY2026 code set.
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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