Ophthalmology Billing Cheat Sheet (2026)
Ophthalmology billing has its own visit code family and its own surgical globals, and the denials cluster where they meet: choosing eye codes versus E/M, billing the injection without the drug, and repeating diagnostics that have a frequency limit.
Quick reference for ophthalmology billers. Last updated .
Top Ophthalmology CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 92014 | Comprehensive eye exam, established patient | $127.26 | $62.13 | 3.81 |
| 92012 | Intermediate eye exam, established patient | $90.52 | $41.42 | 2.71 |
| 92004 | Comprehensive eye exam, new patient | $149.64 | $77.82 | 4.48 |
| 66984 | Cataract extraction with intraocular lens insertion | $462.60 | $462.60 | 13.85 |
| 67028 | Intravitreal injection | $114.23 | $75.49 | 3.42 |
| 92250 | Fundus photography with interpretation | $37.07 | $37.07 | 1.11 |
| 92235 | Fluorescein angiography | $162.33 | $162.33 | 4.86 |
| 92133 | Optical coherence tomography (OCT) of optic nerve | $30.73 | $30.73 | 0.92 |
| 92134 | Optical coherence tomography (OCT) of retina | $32.73 | $32.73 | 0.98 |
| 65855 | Trabeculoplasty by laser surgery | $245.50 | $171.35 | 7.35 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Ophthalmology billing services page.
Modifiers That Prevent Ophthalmology Denials
The eye treated, required on most ophthalmic procedures and many diagnostics for adjudication.
A bilateral procedure where the code is not inherently bilateral and the payer expects modifier 50.
An unrelated E/M during the global period of eye surgery such as cataract extraction (66984).
A significant, separately identifiable E/M on the same day as a minor procedure such as an intravitreal injection.
Split surgical care: postoperative-only (55) or surgical-only (54) when comanaging cataract surgery with an optometrist.
An unrelated procedure, such as surgery on the second eye, during the global of the first.
Top Ophthalmology Denials → Quick Fix
Eye visit codes (92002 to 92014) and E/M codes have different documentation. Pick the family the visit supports and document to it; do not alternate to chase payment.
Bill the injection (67028) and the separately payable drug J-code with units and the JW or JZ wastage modifier. The drug is most of the revenue.
Track payer frequency limits on 92133 and 92134; they cannot both be billed for the same eye on the same day. Document the medical necessity for the interval.
Routine post-op is in the cataract global. Use modifier 24 for an unrelated problem during the global, with documentation.
Append RT or LT (or 50 for bilateral) on procedures and diagnostics where the payer requires the eye to be identified.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 92014 | 0469T | CPT Manual or CMS manual coding instruction |
| 92014 | 0569T | CPT Manual or CMS manual coding instruction |
| 92012 | 0469T | CPT Manual or CMS manual coding instruction |
| 92012 | 0569T | CPT Manual or CMS manual coding instruction |
| 92004 | 0469T | CPT Manual or CMS manual coding instruction |
| 92004 | 36591 | CPT Manual or CMS manual coding instruction |
| 66984 | 00142 | Anesthesia service included in surgical procedure |
| 66984 | 00144 | Anesthesia service included in surgical procedure |
Documentation That Holds Up on Appeal
The required elements for the eye-code level, or document and bill an E/M instead. The two are not interchangeable mid-claim.
The drug, dose, eye, and amount discarded, supporting the J-code units and wastage modifier.
Which structure was imaged and the medical necessity; the two codes are mutually exclusive for the same eye same day.
The procedure and global start, so post-op visits use modifier 24 when unrelated rather than being written off.
The eye treated, supporting RT, LT, or 50.
Revenue Ophthalmology Practices Leave on the Table
Billing the intravitreal injection but not the separately payable drug, forfeiting most of the encounter's value.
Choosing eye codes or E/M by which pays more instead of which the documentation supports, which fails audit.
Losing post-cataract visits to the global when an unrelated problem qualified for modifier 24.
Frequency denials on OCT because the interval medical necessity was not documented.
Ophthalmology Billing FAQ
Eye codes or E/M, which do I use?
Whichever the visit documentation supports. The eye visit codes (92002 to 92014) and E/M codes have different requirements; pick one family and document to it. Alternating to chase reimbursement fails on audit.
How do I bill an intravitreal injection?
The injection procedure (67028) plus the separately payable drug as a J-code with units and JW or JZ for wastage. The drug is the larger part of the payment and is frequently dropped.
Can I bill OCT of the nerve and retina the same day?
No. 92133 and 92134 are mutually exclusive for the same eye on the same day. Bill the one performed, with the medical necessity for the test and its interval documented.
How are post-cataract visits handled?
Routine post-op is in the surgical global and not separately billable. An unrelated problem during the global is billable with modifier 24 and supporting documentation.
Stop Losing Ophthalmology Revenue to Preventable Denials
Our AAPC-certified ophthalmology coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.