2025 CPT code 92014
Comprehensive ophthalmological exam for an established patient, including initiation or continuation of diagnostic and treatment programs.
Modifiers 25, 57, 76, 77, 79, and others may be applicable depending on the specific circumstances of the service provided. Consult the CPT manual and payer guidelines for appropriate modifier use.
The medical necessity for a comprehensive ophthalmological exam (92014) is determined by the patient's presenting symptoms, risk factors, and the need for comprehensive evaluation and management of their ocular health. This would depend upon the clinical findings. This might involve a new symptom, the need to adjust treatment, or a routine follow-up for chronic conditions.
The ophthalmologist reviews the patient's history, performs a complete eye examination, initiates a diagnostic plan, and prescribes necessary treatment, including medication and referrals as needed.The physician is responsible for the overall medical management of the patient's ocular health.
- Medicine Services and Procedures > Ophthalmology Services and Procedures > General Ophthalmological Services and Procedures
- Medicine Services and Procedures > Ophthalmology Services and Procedures > General Ophthalmological Services and Procedures > Established Patient General Ophthalmological Services and Procedures
In simple words: This code covers a complete eye exam for a patient who has seen this doctor or someone in their practice before.The doctor checks your eyes thoroughly, looks at your medical history and makes a plan for any needed treatment or tests.
This CPT code (92014) represents a comprehensive ophthalmological examination and evaluation for an established patient, encompassing the initiation or continuation of diagnostic and treatment plans.The service includes a thorough review of the patient's history, a general medical observation, and a complete examination of the external eye structures, visual fields, and basic sensorimotor functions.Additional diagnostic tests, such as biomicroscopy, tonometry, and ophthalmoscopy with cycloplegia or mydriasis, may be incorporated as clinically indicated.The physician initiates a diagnostic and treatment program which may involve prescribing medication and arranging for further specialized ophthalmological services, consultations, laboratory tests, or radiological studies.
Example 1: An established patient presents with worsening blurry vision and reports increased difficulty with near vision. The ophthalmologist performs a comprehensive eye exam (92014), including visual acuity testing, refraction, slit-lamp biomicroscopy, and ophthalmoscopy, leading to a diagnosis of cataracts and the initiation of treatment planning which may include surgical consultation and pre-operative evaluation., An established patient with a history of glaucoma returns for a routine follow-up visit. The ophthalmologist performs a comprehensive examination (92014), including intraocular pressure measurement, visual field testing, and ophthalmoscopy. The physician reviews the results and adjusts the patient's medication regimen as needed. The existing treatment plan is continued., An established patient complains of eye irritation and redness. The ophthalmologist performs a comprehensive exam (92014), including a detailed examination of the conjunctiva, cornea, and anterior chamber, revealing conjunctivitis.Treatment includes topical eye drops, and patient education.
Complete medical history, visual acuity, gross visual fields, examination of eyelids and adnexa, ocular motility, pupils, iris, conjunctiva, cornea, anterior chamber, lens, intraocular pressure, retina, and optic disc. Detailed notes on any diagnostic tests performed, treatment plan initiated or continued, and any referrals or consultations made.The documentation must clearly justify medical necessity.
** Accurate coding requires thorough documentation of all services performed, including specific diagnostic tests and treatment plans.Always refer to the most current CPT guidelines and payer-specific instructions.
- Revenue Code: M5C (SPECIALIST - OPHTHALMOLOGY)
- RVU: This information is not available in the provided sources and would require access to a current relative value unit (RVU) database or a medical billing software.
- Global Days: The global period is not explicitly defined for this code in the provided data; it would depend on payer-specific guidelines or the individual services rendered.A comprehensive ophthalmologic examination may include ongoing management within a longer global period. Consult payer specific guidelines.
- Payment Status: Active
- Modifier TC rule: This is not a technical component (TC) code; therefore, TC modifiers are not applicable.
- Fee Schedule: Historical fee schedule data is not available in the provided source. Consult a fee schedule database specific to your location and payer.
- Specialties:Ophthalmology
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center