Service Utilization

The Service Utilization indicator included in VEHSS consists of the proportion of patients who underwent an eye exam per year.  The rate of exams represents the proportion of patients who have at least one eye exam during the year of observation, and is a single number representing the average for each patient group.

Table 1. Eye Examination Procedure Codes

Table 1. Eye Examination Procedure Codes
Category Subgroup
Eye Exams By any provider type
By ophthalmologists and other physicians
By optometrists and opticians

The VEHSS system uses Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCPS) codes to measure service use and access to care in administrative claims and electronic medical registry data. Four CPT/HCPCS codes denote an eye exam, and all instances of these procedures are counted as an eye examination.

Table 2. Eye Examination Procedure Codes

Table 2. Eye Examination Procedure Codes
Code Description CPT/HCPCS Code
Eye exam new patient 92002
92004
Eye exam established patient 92012
Eye exam tx estab pt 1/>vt 92014

Other Evaluation & Management (E&M) codes are frequently billed for eye examinations but are not specific to eye examinations. E&M codes are counted as an eye examination if they are coded by an eye care provider.

Table 3. Procedure Codes that Require Provider Specialty Code*

Procedure Codes that Require Provider Specialty Code
Code Description E&M Code
Office/outpatient visit new 99201
99202
99203
99204
99205
Office/outpatient visit est 99212
99213
99214
99215
Office consultation 99241
99242
99243
99244
99245
Home visit new patient 99341
99342
99343
99344
99345
Home visit est patient 99347
99348
99349
99350
*See Table 4 for required specialty codes for use of E&M codes in VEHSS.

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

Table 4. Eye Care Provider Taxonomy Codes

Table 4. Eye Care Provider Taxonomy Codes
Medicare Specialty Code Medicare Provider/Supplier 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
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
96[5] Optician 156FX1800X Eye & Vision Service Providers/Technician/Technologist, Optician