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).
Self-reported receipt of eye exam
The National Health Interview Survey (NHIS) includes questions indicating whether a person had an eye exam.
Dataset
Description
Question Text
Variable Name(s)
Sample
Response Options
NHIS – Adult module
Percentage of adults that had an eye exam from an eye specialist such as an optometrist, ophthalmologist, or eye doctor in the past 12 months
During the past 12 months, have you had an eye exam from an eye specialist such as an optometrist, ophthalmologist, or eye doctor?
EYEEX12M_A
Ages 18 years and older
1 – Yes, 2 – No, 7 – Refused, 9 – Don’t know
NHIS – Adult module
Percentage of adults that had an eye exam in which the pupils were dilated using eye drops less than 1 year, 2 years, 3 years, 5 years, or 5+ years ago
When was the last time you had an eye exam in which the pupils were dilated using eye drops? This may have made you temporarily sensitive to bright light
AVISEXAM_A
Ages 18 years and older
0 – Never, 1 – Within the past year (anytime less than 12 months ago), 2 – Within the last 2 years (1 year but less than 2 years ago), 3 – Within the last 3 years (2 years but less than 3 years ago), 4 – Within the last 5 years (3 years but less than 5 years ago), 5 – 5 years ago or more, 7 – Refused, 9 – Don’t Know
NHIS – Child module
Percentage of children that had an eye exam from an eye specialist such as an optometrist, ophthalmologist, or eye doctor in the past 12 monthss
During the past 12 months, has <child name> had an eye exam from an eye specialist such as an optometrist, ophthalmologist, or eye doctor?
EYEEX12M_C
Ages 0–17 years
1 – Yes, 2 – No, 7 – Refused, 9 – Don’t know
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
Eye exam under general anesthesia
92018, 92019
Dilated macular exam
G9974
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 |
This page was last updated on this date. Updates may include minor edits, image changes, or other modifications to page content.
The information on this page was last reviewed by subject matter experts to ensure accuracy.