Eye Exams

Vision Care Services

What to know

The Vision and Eye Health Surveillance System (VEHSS) reports the prevalence of receiving eye examinations derived from self-reported treatment history from national surveys; payment claims from administrative claims databases; and medical record information from the IRIS Registry of electronic health records (EHRs).

young patient getting eye exam

Self-reported receipt of service

The National Health Interview Survey (NHIS) includes questions indicating whether a person had an eye exam.

Survey

NHIS – Child Module

NHIS – Adult module

Description

Percentage of children whose family members talked to an optometrist, optician, or eye doctor (someone who prescribes eyeglasses) about the child’s health (NHIS Child Module)

Percentage of adults who in the past 12 months have seen or talked to an optometrist, optician, or eye doctor (someone who prescribes eyeglasses)  about their own health (NHIS Adult Module)

Question Text

DURING THE PAST 12 MONTHS, has anyone in the family seen or talked to any of the following health care providers about [fill2: alias]’s health?

An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?

DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?

An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?

Variable name(s)

CHCSYR_2
CHCSYR2

AHCSY1_2
AHCSYR2

Sample

Ages 0-17

Ages 18+

Response options

1 Yes, 2 No, 7 Refused, 9 Don’t know

1 Yes, 2 No, 7 Refused, 9 Don’t know

Explore data in the VEHSS application‎

The data sources available for this category include NHIS and National Survey of Children's Health (NSCH).

Patients receiving eye exams

The VEHSS system uses Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and provider type codes to identify the prevalence of patients receiving eye exams in administrative claims and IRIS Registry data. These prevalence rates and counts only include services that generated an insurance claim or EHR with an included procedure code during the year of observation.

Available subgroups

Category

Subgroup

Eye Exams

  • By any provider type
  • By ophthalmologists and other physicians
  • By optometrists and opticians

The following four CPT codes always denote an eye exam.

Code Description

CPT/HCPCS Code

Eye exam, new patient

92002, 92004

Eye exam, established patient

92012

Eye exam treatment, established patient 1/>visit

92014

The following evaluation and management (E&M) codes may be billed for eye examinations but are not specific to eye examinations. E&M codes are counted as an eye examination in VEHSS if they are accompanied by provider type identifiers indicating an eye care provider.

Code Description

E&M Code

Office/outpatient visit new

99201, 99202, 99203, 99204, 99205

Office/outpatient visit established

99212, 99213, 99214, 99215

Office consultation

99241, 99242, 99243, 99244, 99245

Home visit, new patient

99341, 99342, 99343, 99344, 99345

Home visit, established patient

99347, 99348, 99349, 99350

E&M codes are counted as an eye examination if the provider type taxonomy indicates that the procedure was coded by an ophthalmologist, optometrist, optician, or general physician who coded for an ophthalmic procedure.

Below are the provider taxonomy codes used for Medicare data in VEHSS.

Medicare Specialty Code Medicare Provider Type Description Provider Taxonomy Code Provider Taxonomy Description: Type, Classification, Specialization
2 Physician/ General Surgery 207WX0200X Allopathic & Osteopathic Physicians/Ophthalmic Plastic and Reconstructive Surgery
18 Physician/ ophthalmology 207W00000X Allopathic & Osteopathic Physicians/Ophthalmology
96[5] Optician 156FX1800X Eye & Vision Service Providers/Technician/
Technologist, Optician
41 Optometry 152W00000X Eye and Vision Service Providers/Optometrist
152WC0802X Eye and Vision Service Providers/Optometrist, Corneal and Contact Management
152WL0500X Eye and Vision Service Providers/Optometrist, Low Vision Rehabilitation
152WX0102X Eye and Vision Service Providers/Optometrist, Occupational Vision
152WP0200X Eye and Vision Service Providers/Optometrist, Pediatrics
152WS0006X Eye and Vision Service Providers/Optometrist, Sports Vision
152WV0400X Eye and Vision Service Providers/Optometrist, Vision Therapy

Explore data in the VEHSS application‎

The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, Managed Vision Care, and MarketScan commercial insurance claims.