Revenue Cycle Insider

Do VF testing codes apply to one or both eyes?

Visual field (VF) testing, also known as perimetry, is commonly performed in both ophthalmology and optometry. For example, Medicare utilization data shows approximately 1.9 million claims for VFs were reimbursed to ophthalmologists in 2023. However, in a 2022 Ophthalmology Glaucoma article regarding the use of perimetry to assess and monitor glaucoma researchers found that VF testing is underutilized.

Continue reading to learn about VF testing and how to report the services.

Get to Know the Visual Field CPT^® Codes

The longstanding CPT^® codes describe three separate tests:

• 92081 (Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent))
• 92082 (… intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screen program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33))
• 92083 (… extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30^o, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2))

A physician may perform a limited VF (92081) to screen for potential disease, or to assess eyelid position. When a provider performs a limited VF to determine the extent of impairment prior to possible lid surgery, it is frequently performed with the lids taped and untaped. CPT^® Assistant clarified billing in September 2010: “It is only reported once per session, even when the exam includes evaluations with and without lid taping as in evaluation for blepharoplasty … regardless of whether the examination is performed more than once unilaterally or bilaterally.” 

Automated intermediate VF (92082) usually involves an abbreviated testing protocol to determine an absolute or relative defect. It is not quantified like a full threshold test. For a manual test, 92082 requires at least two isopters.

Extended VF (92083) requires at least three isopters or the equivalent of a full threshold automated VF. A full threshold test provides quantitative data (in decibels or apostilbs) for each location.

The Medicare National Coverage Determinations [NCDs] Manual, section 80.9, states, “Computer enhanced perimetry involves the use of a micro-computer to measure visual sensitivity at preselected locations in the visual field. It is a covered service when used in assessing visual fields in patients with glaucoma or other neuropathologic defects.”

To this point, the introduction to the NCD manual states, “Where coverage of an item/service is provided for specified indications or circumstances but is not explicitly excluded for others, or where the item/service is not mentioned at all in the Centers for Medicare & Medicaid Services (CMS) NCD Manual the Medicare Administrative Contractor (MAC) has the discretion to make the coverage decision.” Consequently, it is necessary to check your local Medicare coverage policy for additional information regarding covered indications and diagnoses beyond the NCD. 

VFs are defined in the CPT^® code book as “unilateral or bilateral” so you’ll make a solitary charge whether the physician tests one or two eyes. Furthermore, a physician’s order in the medical record and written interpretation are required.

The visual field codes are mutually exclusive with each other, so in the unusual case where you are performing more than one type of VF on the same day for an individual patient, bill for only one. The minimal evaluation and management (E/M) exam, 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional), is bundled with VF.

Dive Into Documentation Guidelines

Selecting the correct codes for the physician’s procedure and diagnoses require careful examination of their documentation. The documentation needs to meet certain requirements to back up your code assignment. Two factors to keep in mind when reviewing documentation include supervision and orders.

Supervision: Medicare has established three different levels of physician supervision of technicians, commensurate with the risk to the patient and the skills required to obtain useful results. VF testing requires “general supervision.” This means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the procedure. Under general supervision, the training of the nonphysician personnel who perform the test and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician. 

Orders: The physician does not personally perform all diagnostic tests (for example, gonioscopy and extended ophthalmoscopy require a physician’s order). Technicians may not order diagnostic tests. The order may be a notation as simple as “VF today” or “VF next visit.” It should include the medical rationale for the test for that specific patient and visit, especially if it is not immediately obvious to a reviewer.

Medical rationale, or indications for visual fields, may vary by payer. While most policies list glaucoma, physicians may need to assess conditions affecting the optic nerve or visual pathway, or monitor patients on high-risk medication and some retinal conditions.

A diagnosis of “glaucoma suspect” is supported by some but not all payer policies, and some plans that do allow VF testing for glaucoma suspect may limit the frequency to once per year. Check the policy or consider submitting a preauthorization if the provider is considering more frequent testing.

Identify the Importance of the Interpretation and Report

For VFs, like many diagnostic tests, the CPT^® descriptor includes “with interpretation and report.” In the absence of an interpretation by the physician, the test is incomplete and of little value. The interpretation and report must answer pertinent questions about the service. A cryptic, one-word note or short phrase isn’t likely sufficient.

Tests like perimetry are more valuable for making decisions about treatment when there is a series. Does the series demonstrate disease progression? For a visual field, the interpretation and report might read as follows:

• July 1, 2026
• Technician: Mary Smith, COA
• 1 false positive
• Good patient cooperation
• Arcuate scotoma, OU
• POAG, progressing since last test
• On maximum tolerated medical therapy, discussed surgical/laser options with patient
• Signed: I. C. Better, M.D.

Learn How Modifiers Can Affect Reimbursement

The Medicare Physician Fee Schedule lists different payment rates for the professional and technical components of diagnostic tests where there is discrete reimbursement for an “interpretation and report.” Modifiers 26 (Professional component) and TC (Technical component) make the distinction between the professional and technical portions of the test. This permits a technician or medical assistant to perform the technical component, with appropriate supervision; only the physician can interpret the results.

When the modifiers are not appended to a CPT^® code, the payer understands that reimbursement is sought for the technical and professional components in a single payment. Payment is no different when filing on separate lines with TC and 26 or as a single service with no modifiers.

Watch out for These Common Documentation and Claims Errors

Claim errors related to VFs are usually based on incomplete or inaccurate information on the claim.

To improve your charting:

• Include a written order by the physician, including the rationale for the test,
• Retain the printout of the test, and 
• Document the interpretation in a timely manner.

Follow this advice to improve the accuracy of the claims:

• Verify that you have billed the correct level of field; 92083 is the most commonly reported code.
• Confirm that the diagnosis listed on the claim is a covered diagnosis in the payer’s policy.
• Watch modifiers. Use TC or 26 when appropriate and understand that modifiers 50 (Bilateral procedure), RT (Right side), and LT (Left side) are not expected.

Remember These Coding Keys

When a VF testing case enters your workflow, you should take the following steps into account before selecting your codes:

• VF codes are reimbursed as bilateral with one claim for both eyes. 
• The codes require only general supervision.
• A separate payment can be made for the technical or professional component when it’s appropriate.
• National Correct Coding Initiative (NCCI) edits allow you to bill one test per claim.
• Coverage indications (billable diagnoses) can vary by payer, so it’s best to check with your carriers.

Conclusion

Perimetry is a valuable diagnostic test used frequently in ophthalmology and optometry. Claims for ophthalmic diagnostic tests are supported by clinical indications, as well as the physician order and interpretation, and visual field tests are no exception.   

Mary Pat Johnson, COMT, CPC, COE, CPMA,
Senior Consultant, Corcoran Consulting Group