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
| 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 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
| 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 |