What Happened to CPT Code 92002?
CPT code 92002 was an ophthalmology-specific evaluation and management code for an intermediate new patient eye examination. It was deleted from the CPT code set effective January 1, 2023, along with all four eye-specific E/M codes (92002, 92004, 92012, 92014), when CMS and the AMA transitioned ophthalmology to the standard office visit E/M code set (99202 through 99215). As of 2026, any claim submitted with CPT 92002 will deny because the code no longer exists. Ophthalmology practices must use the standard E/M codes, selecting the level based on medical decision making or total time, the same framework used by every other medical specialty.
Code status: CPT 92002 was deleted January 1, 2023. It cannot be billed to any payer. Claims submitted with 92002 deny automatically.
What replaced it: Standard E/M codes 99202 through 99205 (new patients) and 99211 through 99215 (established patients) replaced all four deleted eye codes.
Key difference: The old eye codes were selected based on exam complexity (intermediate vs comprehensive). The replacement E/M codes are selected based on medical decision making complexity or total provider time spent on the encounter.
Why CMS Deleted the Eye Codes
The four ophthalmology-specific E/M codes (92002, 92004, 92012, 92014) existed because ophthalmology examinations historically followed a different evaluation framework than standard office visits. The eye codes were selected based on the complexity of the ophthalmic examination itself: 92002 and 92012 for intermediate exams, 92004 and 92014 for comprehensive exams.
In 2021, CMS restructured the standard E/M code set (99202 through 99215) to base code selection on medical decision making (MDM) complexity or total time, eliminating the history and physical exam documentation requirements that had previously driven E/M level selection. Once the standard E/M codes no longer required exam documentation to determine the level, the rationale for maintaining a separate eye-specific code set disappeared. The AMA CPT Editorial Panel deleted the four eye codes effective January 1, 2023, and ophthalmology joined every other specialty in using the standard E/M framework.
In our experience matching ophthalmology providers with billing partners, the transition created two lasting problems that persist into 2026. First, some billing teams still have 92002 in their EHR charge templates and do not catch it until the claim denies. Second, many ophthalmology practices undercode their standard E/M visits because they are accustomed to the two-tier eye code system (intermediate or comprehensive) and default to the lower E/M levels rather than documenting the medical decision making that supports a higher level.
What Replaced CPT 92002?
| Old Eye Code | Patient Type | Exam Level | Replacement E/M Code(s) | Selection Basis |
|---|---|---|---|---|
| 92002 | New patient | Intermediate | 99202 or 99203 | MDM or total time |
| 92004 | New patient | Comprehensive | 99204 or 99205 | MDM or total time |
| 92012 | Established patient | Intermediate | 99212 or 99213 | MDM or total time |
| 92014 | Established patient | Comprehensive | 99214 or 99215 | MDM or total time |
The crosswalk is not a one-to-one replacement. The old 92002 (intermediate new patient) does not automatically become 99202 (straightforward new patient). The correct replacement code depends on the medical decision making documented in the encounter, not on the exam complexity. An ophthalmologist who performs what would have been an intermediate exam under the old system but whose MDM involves moderate complexity (multiple diagnoses, prescription management, reviewing external records) should bill 99204, not 99202. The exam is the same, but the billing logic changed.
This is the most common revenue gap we see in ophthalmology practices that transitioned from the eye codes. A practice billing 99202 or 99203 for visits that support 99204 based on MDM is leaving $50 to $80 per visit on the table. Over a year of new patient volume, that adds up to tens of thousands of dollars in lost revenue from undercoding. For how refractive and myopia diagnosis codes pair with the E/M levels, see our ICD-10 H52.03 billing guide.
How Do Ophthalmologists Select the Right E/M Code?
Under the current E/M framework, ophthalmologists select the office visit code using one of two methods: medical decision making complexity or total time. Most ophthalmology practices use MDM because it aligns better with the clinical workflow.
Medical decision making has three components, and the level is determined by the two highest of the three:
1. Number and complexity of problems addressed. A patient presenting with a single self-limited problem (conjunctivitis) supports a lower MDM level than a patient with multiple chronic conditions (glaucoma plus diabetic retinopathy plus dry eye).
2. Amount and complexity of data reviewed. Reviewing external records, ordering and interpreting tests (OCT, visual fields, fluorescein angiography), and discussing results with other providers all increase the data complexity. For practices billing OCT imaging (CPT 92134) alongside the office visit, the review and interpretation of that imaging contributes to the data element of MDM.
3. Risk of complications, morbidity, or mortality. Prescribing a new medication, recommending surgery, or managing a condition with a risk of vision loss increases the risk element. An ophthalmologist managing glaucoma with medication adjustments documents moderate risk, which supports 99214.
The key insight for ophthalmology practices is that MDM complexity in eye care is often higher than the billing team realizes. A routine-seeming glaucoma follow-up that involves reviewing OCT and visual field results, adjusting IOP-lowering medications, and discussing surgical options if the target pressure is not met documents moderate MDM and supports 99214, not 99213.
The transition from the eye codes to standard E/M changed how every ophthalmology office visit is billed. If your practice is still defaulting to 99202 or 99212 for visits that document moderate medical decision making, you are undercoding every claim. An ophthalmology billing partner who understands MDM-based E/M selection catches the revenue your team is leaving behind. Ophthalmology Bill Co matches your practice with vetted billing companies, free.
Common Ophthalmology E/M Billing Errors
Across the billing companies we vet for ophthalmology practices, five E/M coding errors persist from the eye code transition.
- Submitting 92002 or 92004 on claims. These codes were deleted in 2023. Any claim with a deleted eye code denies automatically. Check your EHR charge templates and remove the deleted codes entirely.
- Defaulting to 99202/99212 for all visits. Many practices replaced the old intermediate code with the lowest new-patient or established-patient E/M level. The replacement should be based on MDM, not on a blanket crosswalk. Most ophthalmology visits support 99203 or 99213 at minimum, and many support 99204 or 99214.
- Not documenting MDM complexity. The exam findings alone no longer determine the E/M level. The note must document the number of problems addressed, the data reviewed, and the risk of the management plan. Without explicit MDM documentation, the billing team cannot code above the lowest level.
- Ignoring the time-based option. For visits where the ophthalmologist spends significant time on counseling, care coordination, or reviewing complex records, total time may support a higher E/M level than MDM. Time-based coding requires documenting the total time spent on the encounter date, including non-face-to-face time.
- Billing the eye exam and a separate E/M on the same date without modifier 25. When an ophthalmologist performs a separately identifiable E/M service on the same day as a procedure or diagnostic test, modifier 25 must be appended to the E/M code. Missing modifier 25 results in a denial of the E/M component. Learn more about how Ophthalmology Bill Co connects practices with billing experts who handle these modifier rules daily.
Ophthalmology E/M Reimbursement in 2026
| E/M Code | Patient Type | MDM Level | 2026 Medicare (non-facility) |
|---|---|---|---|
| 99202 | New | Straightforward | ~$72 |
| 99203 | New | Low | ~$114 |
| 99204 | New | Moderate | ~$172 |
| 99205 | New | High | ~$222 |
| 99212 | Established | Straightforward | ~$52 |
| 99213 | Established | Low | ~$97 |
| 99214 | Established | Moderate | ~$143 |
| 99215 | Established | High | ~$193 |
The revenue difference between levels is significant. A practice billing 99213 instead of 99214 for an established patient visit that supports moderate MDM loses approximately $46 per visit. At 40 established patient visits per day across a multi-provider practice, that undercoding gap is $1,840 per day, or approximately $460,000 per year. The eye code transition did not reduce ophthalmology reimbursement. It changed the documentation and coding logic. Practices that adapted their documentation to the MDM framework are billing at the correct levels. Practices that did not are systematically undercoding.
Frequently Asked Questions
No. CPT 92002 was deleted from the CPT code set effective January 1, 2023. It cannot be billed to any payer. Claims submitted with 92002 will deny automatically. Ophthalmology practices must use the standard E/M codes (99202 through 99215) for all office visits.
Standard E/M codes 99202 through 99205 (new patients) replaced CPT 92002 and 92004. The specific code depends on the medical decision making complexity or total time documented for the visit, not on the exam complexity that determined the old eye code level.
CMS restructured the standard E/M codes in 2021 to base code selection on medical decision making or time, eliminating the exam-based documentation requirements. Once the standard E/M framework no longer required exam documentation, the separate eye-specific codes were redundant and the AMA deleted them effective 2023.
Select the code based on medical decision making complexity. 99202 is for straightforward MDM (one self-limited problem, minimal data, minimal risk). 99204 is for moderate MDM (multiple chronic conditions, ordering and reviewing tests, prescription management). Most new ophthalmology patients with a clinical question beyond a basic refraction support 99203 or 99204.
No. The eye-specific E/M codes (92002, 92004, 92012, 92014) are all deleted. The ophthalmological examination is now part of the standard E/M visit, and the code level is determined by MDM or time, not by exam complexity. Diagnostic tests like OCT (92134) and visual fields (92083) are billed separately from the E/M.
Not inherently. The standard E/M codes reimburse at rates comparable to or higher than the old eye codes when the correct level is billed. However, practices that default to lower E/M levels because they are unfamiliar with MDM-based coding are underbilling compared to what their documentation supports, which effectively reduces their reimbursement.
Next Steps
For OCT billing alongside E/M visits and how imaging review supports MDM complexity, see our CPT 92134 billing guide.
For myopia and refractive diagnosis coding on E/M encounters, see our ICD-10 H52.03 guide.
Remove CPT 92002, 92004, 92012, and 92014 from your EHR charge templates if they are still there.
Ready to stop undercoding your ophthalmology E/M visits? Get matched with a billing partner who knows MDM-based coding.
The eye codes are gone, but the revenue is still there if your documentation and coding match the MDM framework. Every ophthalmology visit billed at 99213 when the documentation supports 99214 is $46 lost. Ophthalmology Bill Co matches your practice with vetted billing companies that specialize in ophthalmology E/M coding. Free quotes, all 50 states, rates starting at 2.95%.
