Service Utilization
VEHSS reports the utilization of eye care services as the percentage of persons or patients within each dataset who had record of at least one instance of an eye care service per calendar year of data.
Self-reported Indicators
Further details of all self-reported indicators and analysis methods are available in the following VEHSS technical documentation:
Review of National Survey Data on Eye Health CDC pdf icon[PDF – 1.2 MB]external icon
VEHSS Survey Analysis Plan CDC pdf icon[PDF – 480 KB]external icon
Payment Claims and Medical Records
VEHSS uses CPT and HCPCS procedure codes, NDC drug codes, ICD9 and ICD10 diagnosis codes and CMS provider taxonomy codes to identify service utilization in administrative claims and electronic medical registry data.
Further details on VEHSS’ administrative claims and registry indicators and analysis methods are available in the following VEHSS technical documentation:
VEHSS Claims and Registry Data Analysis Plan CDC pdf icon[PDF – 580 KB]external icon
VEHSS includes indicators of Age-related Macular Degeneration Treatment from payment claims in administrative claims databases, and medical record information as well as claims in the IRIS Registry.
Payment Claims and Medical Records
Age-related Macular Degeneration (AMD) Payment Claims and Medical Records indicate treatments or diagnostic tests commonly associated with AMD among patients with a diagnosis of AMD during the year of observation. AMD Payment Claims and Medical Records include the following subgroups:
| Subgroup | Included Procedures | Procedure Codes |
|---|---|---|
| Intravitreal Injections | Intravitreal injection of pharmacologic agent (separate procedure) | 67028 with anti-VEGF NDC ( 61755-005-02, 61755-005-55, 50242-080-02, 50242-0080-02, 50242-080-03, 50242-0080-03, 50242-060-01, 50242-060-10), OR 67028 with AMD diagnosis |
| Injection, aflibercept | J0178 | |
| Injection, ranibizumab | J2778 | |
| Injection, bevacizumab, unclassified injectable, or compounded drug | C9257, J9035 | |
| Unclassified drugs used in medical care | J3490 | |
| Unclassified biologics used in medical care | J3590 | |
| Compounded drugs | J7999 | |
| Laser/photocoagulation therapy | Destruction Procedures on the Retina or Choroid, photocoagulation | 67220 |
| Destruction Procedures on the Retina or Choroid, photocoagulation | G0186 | |
| Photodynamic therapy | Destruction Procedures on the Retina or Choroid, Photodynamic Therapy | 67221 |
| Destruction Procedures on the Retina or Choroid, Photodynamic Therapy, second eye | 67225 | |
| Verteporfin injection | J3396 |
| Dataset | Years analyzed | Measure type |
|---|---|---|
| IRIS Registry | 2016, 2017, 2018 | Medical Record or Claim |
| Medicare 100% FFS claims | 2014, 2015, 2016, 2017 | Payment Claims |
| Medicaid MAX | 2013, 2014 | Payment Claims |
| MarketScan commercial | 2016 | Payment Claims |
VEHSS includes indicators of Cataract Surgery from self-reported treatment history from surveys, payment claims from claims databases, and medical record or claims from IRIS Registry.
Self-reported
Cataract Surgery includes self-response survey questions indicating that the respondent had a cataract operation.
| Survey | Description | Question text | Variable name(s) | Years available | Years analyzed | Response options |
|---|---|---|---|---|---|---|
| NHANES | Percentage of people who had a cataract operation | {Have you/Has SP} ever had a cataract operation? | VIQ070, VIQ071 | 2005, 2008 | 2005, 2008 | 1 Yes 2 No 7 Don’t know / Not sure 9 Refused |
| NHIS | Percentage of adults who ever had cataract surgery (NHIS Adult Module) | Have you ever had cataract surgery? | VIMCSURG | 2016 | 2016 |
Payment Claims and Medical Records
Cataract Surgery Payment Claims and Medical Records indicate treatments or diagnostic tests commonly associated with cataract surgery among patients with a diagnosis of cataract anytime during the year of observation. Cataract Payment Claims and Medical Records include the following subgroups:
| Subgroup | Included Procedures | Procedure Codes |
|---|---|---|
| Cataract Surgery | Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy) | 66830 |
| Removal of lens material; aspiration technique, 1 or more stages | 66840 | |
| Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration | 66850 | |
| Removal of lens material; pars plana approach, with or without vitrectomy | 66852 | |
| Removal of lens material; intracapsular | 66920 | |
| Removal of lens material; intracapsular, for dislocated lens | 66930 | |
| Removal of lens material; extracapsular (other than 66840, 66850, 66852) | 66940 | |
| Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification) | 66982 | |
| Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure) | 66983 | |
| Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification) | 66984 | |
| Under Incision Procedures on the Lens of the Eye | 66821 | |
| Posterior chamber intraocular lens | V2632 | |
| Astigmatism correcting function of intraocular lens | V2787 | |
| Presbyopia correcting function of intraocular lens | V2788 |
| Dataset | Years analyzed | Measure type |
|---|---|---|
| IRIS Registry | 2016, 2017, 2018 | Medical Record or Claim |
| Medicare 100% FFS claims | 2014, 2015, 2016, 2017 | Payment Claims |
| Medicaid MAX | 2013, 2014 | Payment Claims |
| MarketScan commercial | 2016 | Payment Claims |
VEHSS includes indicators of Diabetic Retinopathy Treatment from payment claims from claims databases, and medical record and claims from the IRIS Registry.
Payment Claims and Medical Records
Diabetic Retinopathy Payment Claims and Medical Records indicate treatments or diagnostic tests commonly associated with Diabetic Retinopathy among patients with diagnosis of Diabetic Retinopathy anytime during the year of observation. Diabetic Retinopathy Payment Claims and Medical Records include the following subgroups:
| Subgroup | Included Procedures | Procedure Codes |
|---|---|---|
| Intravitreal Injections | Intravitreal injection of pharmacologic agent (separate procedure) | 67028 with one NDC ( 61755-005-02, 61755-005-55, 50242-080-02, 50242-0080-02, 50242-080-03, 50242-0080-03, 50242-060-01, 50242-060-10)
OR 67028 with DR diagnosis |
| aflibercept | J0178 | |
| ranibizumab | J2788 | |
| bevacizumab | J9035, J3490, J3590 | |
| Unclassified biologics used in medical care | J3590 | |
| Unclassified drugs used in medical care | J3490 | |
| Laser Surgery or Photocoagulation | Repair Procedures on the Retina or Choroid | 67105 |
| Prophylaxis Procedures on the Retina or Choroid | 67145 | |
| Destruction of localized lesion of retina (e.g., macular edema, tumors), 1 or more sessions; cryotherapy, diathermy | 67208 | |
| Destruction of localized lesion of retina (e.g., macular edema, tumors), 1 or more sessions; photocoagulation | 67210 | |
| Destruction of localized lesion of retina (e.g., macular edema, tumors), 1 or more sessions; radiation by implantation of source (includes removal of source) | 67218 | |
| Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photocoagulation 1 or more sessions | 67220 | |
| Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), cryotherapy, diathermy | 67227 | |
| Treatment of extensive or progressive retinopathy (e.g., diabetic retinopathy), photocoagulation | 67228 | |
| Treatment of extensive or progressive retinopathy, 1 or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (e.g., retinopathy of prematurity), photocoagulation or cryotherapy | 67229 | |
| Unlisted procedures on the retina | 67299 | |
| Repair of retinal detachment | Repair of retinal detachment; with vitrectomy, any method | 67108 |
| Repair of complex retinal detachment (micropulse/retinex) | 67113 | |
| Vitrectomy | Vitrectomy, mechanical, pars plana approach | 67036 |
| Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation | 67039 | |
| Vitreous procedures on the posterior segment of the eye | 67040 | |
| Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (e.g., macular pucker) | 67041 |
| Dataset | Years analyzed | Measure type |
|---|---|---|
| IRIS Registry | 2016, 2017, 2018 | Medical Record or Claim |
| Medicare 100% FFS claims | 2014, 2015, 2016, 2017 | Payment Claims |
| Medicaid MAX | 2013, 2014 | Payment Claims |
| MarketScan commercial | 2016 | Payment Claims |
VEHSS includes indicators of Eye Examinations from self-reported treatment history from surveys, payment claims from claims databases, and medical record or claims from IRIS Registry.
Self-reported
Eye Examinations includes self-response survey questions indicating that the respondent had an eye exam.
| Survey | Description | Question text | Variable name(s) | Years available | Years analyzed | Response options |
|---|---|---|---|---|---|---|
| NHIS | Percentage of children with their vision tested | Has [fill: SC name] EVER had [fill: his/her] vision tested by a doctor or other health professional? | CVISTST | 2016 | 2016 | |
| NHIS | Percentage of families that talked to an optometrist, ophthalmologist, or eye doctor about child’s health in the past 12 months | 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? | CHCSYR1_2 CHCSYR11 CHCSYR_2 CHCSYR2 |
2016 | 2016 | An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)? |
| NHIS | Percentage of adults that talked to eye health provider about health | DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health? | AHCSY1_2 AHCSYR2 |
2016 | 2016 | An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)? |
Payment Claims and Medical Records
VEHSS distinguishes eye examinations by provider type (Table 1).
Table 1. Eye Examination Subgroups
| 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
| 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*
| 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 VEHSS Claims and Registry analysis report 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
| 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 |
| Dataset | Years analyzed | Measure type |
|---|---|---|
| IRIS Registry | 2016, 2017, 2018 | Medical Record or Claim |
| Medicare 100% FFS claims | 2014, 2015, 2016, 2017 | Payment Claims |
| Medicaid MAX | 2013, 2014 | Payment Claims |
| MarketScan commercial | 2016 | Payment Claims |
VEHSS includes indicators of Glaucoma Treatment from payment claims from claims databases and medical record and claims from IRIS Registry.
Payment Claims and Medical Records
Glaucoma Payment Claims and Medical Records indicate treatments or diagnostics tests commonly associated with Glaucoma among patients with diagnosis of Glaucoma anytime during the year of observation. Glaucoma Payment Claims and Medical Records include the following subgroups:
| Subgroup | Included Procedures | Procedure Codes |
|---|---|---|
| Drain | Transluminal dilation of aqueous outflow canal; with and without retention of device or stent | 66174, 66175 |
| Shunt procedure: Aqueous shunt to reservoir, Shunt Procedures on the Anterior Sclera of the Eye | 66179, 66180, 66183, 66184, 66185, 67255 | |
| Additional shunt HCPC codes. Can be included in category above. | C1783, L8612, 0191T, 0253T, 0376T, 0444T, 0445T, 0449T, 0450T, 0474T, 0X46T, 0X47T | |
| Surgery – Incisional | Goniotomy | 66990 |
| Trabeculectomy/Excision Procedures on the Anterior Sclera of the Eye | 66150, 66170, 66172 | |
| Iridectomy/Incision Procedures on the Iris, Ciliary Body of the Eye | 66500, 66505, 66600, 66625, 66630 | |
| Surgery – Laser | Laser trabeculoplasty/Incision Procedures on the Anterior Chamber of the Eye | 65820, 65850, 65855 |
| Cyclophotocoagulation/Laser iridotomy /Destruction Procedures on the Iris, Ciliary Body of the Eye | 66700, 66710, 66711, 66761, 66762 |
| Dataset | Years analyzed | Measure type |
|---|---|---|
| IRIS Registry | 2016, 2017, 2018 | Medical Record or Claim |
| Medicare 100% FFS claims | 2014, 2015, 2016, 2017 | Payment Claims |
| Medicaid MAX | 2013, 2014 | Payment Claims |
| MarketScan commercial | 2016 | Payment Claims |
VEHSS includes indicators of need for vision care from self-reported history from surveys.
Self-reported
| Survey | Description | Question text | Variable name(s) | Years available | Years analyzed | Response options |
|---|---|---|---|---|---|---|
| NSCH | Percentage of children who needed vision care in the past 12 months but did not receive it | DURING THE PAST 12 MONTHS, was there any time when this child needed health care but it was not received? By health care, we mean medical care as well as other kinds of care like dental care, vision care, and mental health services. [MARK ALL THAT APPLY] | K4Q27 k4q28x03 |
2016, 2017 | 2016, 2017 | 1 Yes 2 No |
| NHIS | Use of eye protection while participating in eye risk activities | When doing these activities, on average, does [fill: he/she] wear eye protection always, most of the time, some of the time, or none of the time? | CVISPROT | 2016 | 2016 |
VEHSS includes indicators of Population Screening from self-reported history from surveys, payment claims from claims databases, and medical record or claims from IRIS Registry.
Self-Reported
Vision Screening includes self-response survey questions indicating that the respondent had a vision test or screening.
| Survey | Description | Question text | Variable name(s) | Years available | Years analyzed | Response options |
|---|---|---|---|---|---|---|
| NSCH | Percentage of children who have ever had their vision tested with pictures, shapes, or letters | Has this child EVER had his or her vision tested with pictures, shapes, or letters? | K4Q31_R | 2016, 2017 | 2016, 2017 | 1 Yes 2 No |
| NSCH | Percentage of children who have ever had their vision tested with pictures, shapes, or letters at eye doctor or specialist, pediatrician/general doctor’s office, clinic or health, school, or other | If yes, what kind of place or places did this child have his or her vision tested? Mark ALL that apply. | k4q32x01 k4q32x02 k4q32x03 k4q32x04 k4q32x05 |
2016, 2017 | 2016, 2017 | 1 Yes 2 No |
Payment Claims and Medical Records
Glaucoma screening indicate services for population screening for glaucoma among all patients. Glaucoma screening includes the following subgroup:
| Subgroup | Included Procedures | Procedure Codes |
|---|---|---|
| Retinal imaging telemedicine | Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral | 92227 |
| Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral | 92228 | |
| Glaucoma screening | Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist | G0117 |
| Glaucoma screening for high-risk patient furnished under the direct supervision of an optometrist or ophthalmologist | G0118 | |
| Vision screening | Vision screening | 99174, 99177 |
| Dataset | Years analyzed | Measure type |
|---|---|---|
| IRIS Registry | 2016, 2017, 2018 | Medical Record or Claim |
| Medicare 100% FFS claims | 2014, 2015, 2016, 2017 | Payment Claims |
| Medicaid MAX | 2013, 2014 | Payment Claims |
| MarketScan commercial | 2016 | Payment Claims |
VEHSS includes indicators of Tests and Imaging from payment claims from claims databases and medical record and claims from IRIS Registry.
Payment Claims and Medical Records
Tests and imaging procedures include diagnostic tests regardless of diagnosis. Tests and Imaging Payment Claims and Medical Records include the following subgroups:
| Subgroup | Included Procedures | Procedure Codes |
|---|---|---|
| Gonioscopy | Gonioscopy | 920100, 92020 |
| Visual field | Visual field testing | 92180, 92182, 92183 |
| Tonography | Tonography | 921400, 92100, 92130, 92135 |
| OCT | Optical coherence tomography | 92133, 92134 |
| Fundus | Stereo biomicroscopic exam of the fundus | 92250 |
| angiography | Fluorescein angiography | 92235, 92242 |
| Dataset | Years analyzed | Measure type |
|---|---|---|
| IRIS Registry | 2016, 2017, 2018 | Medical Record or Claim |
| Managed Vision Care | 2016, 2017 | Payment Claims |
| Medicare 100% FFS claims | 2014, 2015, 2016, 2017 | Payment Claims |
| Medicaid MAX | 2013, 2014 | Payment Claims |
| MarketScan commercial | 2016 | Payment Claims |
VEHSS includes indicators of Vision Correction from self-reported history from surveys.
Self-Reported
Vision Correction includes self-response survey questions indicating that the respondent wears glasses.
| Survey | Description | Question text | Variable name(s) | Years available | Years analyzed | Response options |
|---|---|---|---|---|---|---|
| NHIS | Percentage of people who wear glasses (NHIS Functioning and Disability Module) | Do you wear glasses? | VIS_0 | 2012-2017 | 2014-2015 | 1 Yes 2 No 7 Refused 9 Don’t know |
| NHIS | Percentage of children who wear glasses to see far | Does [fill: SC name] wear eyeglasses or contact lenses to read road and street signs, see the blackboard, play sports, watch TV, or see things in the distance? | CVISDIST | 2016 | 2016 | |
| NHIS | Percentage of children who wear glasses to see near | Does [fill: SC name] wear eyeglasses or contact lenses to read books, write, play hand-held games, or do other things that require [fill: him/her] to see well up close? | CVISREAD | 2016 | 2016 |
VEHSS includes indicators of Vision Rehabilitation and Low Vision Aids and Devices from survey self-report.
Self-reported
Includes self-response survey questions indicating that the respondent uses vision services or adaptive devices for low vision. Both questions are asked only among persons who reported trouble seeing.
| Survey | Description | Question text | Variable name(s) | Years available | Years analyzed | Response options |
|---|---|---|---|---|---|---|
| NHIS | Percentage of persons who have trouble seeing that use vision rehabilitation services (NHIS Adult Module) | Do you use any vision rehabilitation services, such as job training, counseling, or training in daily living skills and mobility? | AVISREH | 2016, 2017 | 2016, 2017 | 1 Yes 2 No 7 Refused 8 Not ascertained 9 Don’t know |
| NHIS | Percentage of persons who have trouble seeing that use adaptive devices (NHIS Adult Module) | Do you use any adaptive devices such as telescopic or other prescriptive lenses, magnifiers, large print or talking materials, CCTV, white cane, or guide dog? | AVISDEV, AVIS_DEV | 2016, 2017 | 2016, 2017 | 1 Yes 2 No 7 Refused 8 Not ascertained 9 Don’t know |
VEHSS includes indicators of the use of eye protection from survey self-report.
Self-reported
Includes self-response survey questions indicating that the respondent engages in activities that could cause eye injury, and if yes, how often they use eye protection.
| Survey | Description | Question text | Variable name(s) | Years available | Years analyzed | Response options |
|---|---|---|---|---|---|---|
| NHIS | Percentage of persons who participate in activities that can cause eye injury (NHIS Adult Module) | Outside of work, do you participate in sports, hobbies, or other activities that can cause eye injury? This includes activities such as baseball, basketball, mowing the lawn, wood working, or working with chemicals. | AVISACT | 2016, 2017 | 2016, 2017 | 1 Yes 2 No 7 Refused 8 Not ascertained 9 Don’t know |
| NHIS | Percentage of adults who participate in activities which may cause injury that wear eye protection (NHIS Adult Module) | When doing these activities, on average, do you wear eye protection always, most of the time, some of the time, or none of the time? | AVISPROT | 2016, 2017 | 2016, 2017 | 1 Always 2. Most of the time 3. Some of the time 4. None of the time 7. Refused 8. Not ascertained 9. Don’t know |
| NHIS | Percentage of children (ages 6-17) who participate in sports, hobbies, or other activities that can cause eye injury (NHIS Child Module) | Does [fill: SC name] participate in sports, hobbies, or other activities that can cause eye injury? This includes activities such as baseball, basketball, soccer and mowing the lawn | CVISACT | 2016, 17 | 2016, 17 | 1 Yes 2 No 7 Refused 8 Not ascertained 9 Don’t know |
| NHIS | Percentage of persons who have trouble seeing that use adaptive devices (NHIS Child Module) | When doing these activities, on average, do you wear eye protection always, most of the time, some of the time, or none of the time? | CVISPROT | 2016, 17 | 2016, 17 | 1 Always 2. Most of the time 3. Some of the time 4. None of the time 7. Refused 8. Not ascertained 9. Don’t know |