CPT Code 92002: Ophthalmological Services, New Patient, Intermediate

Learn more about how to properly use and bill CPT code 92002 with our guide that comes complete with documentation requirements and billing guidelines.

Use Code

What is the CPT code 92002?

CPT code 92002, one of the ophthalmology CPT codes developed by the American Medical Association, is used to report an intermediate-level ophthalmologic evaluation for a new patient. It's also described as "Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient." This code falls under New Patient General Ophthalmological Services and Procedures.

The services in this code includes a gathering of medical history, general ocular and adnexal examination, external and ophthalmoscopic examination, basic medical decision making, and initiation of a diagnostic and treatment program.

CPT code 92002 documentation requirements

Documentation should include:

Confirmation of new patient status (not seen within the past 3 years)
Reason for the visit and relevant ocular/systemic history
Detailed eye exam that includes but isn't limited to: visual acuity testing; external eye inspection, adnexal structures, and ocular motility; and basic evaluation of anterior and posterior segments
Diagnosis, treatment plan, and education that reflect the complexity of the decision-making involved
Initiation of diagnostic and treatment program
Patient instructions

CPT code 92002 billing guidelines

Here's a list of the billing gudelies for billing code 92002:

Use only for new patients (not seen by the provider or group in the past 3 years).
Must be billed for the medical necessity of an intermediate eye exam
Appended with the necessary modifiers, depending on the specific circumstances
Refractions (92015) and diagnostic tests (e.g., 92250, 92134) are not included and may be billed separately.

Do note that even if the Centers for Medicare and Medicaid Services generally reimburses the code, the rates may vary depending on the location and plan details. Additionally, reimbursement may be subject to National Correct Coding Initiative (NCCI) edits, which can impact whether certain services can be billed together.

Other relevant CPT codes

92004: Comprehensive ophthalmological services (detailed evaluation of the complete visual system), new patient
92012: Intermediate exam, established patient
99202–99205: E/M codes for new patient office visits