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:

Age-related Macular Degeneration (AMD) Payment Claims and Medical Records
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
Payment Claims and Medical Records Data Sources
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.

Self-report Cataract Surgery Indicators
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:

Cataract Surgery Payment Claims and Medical Records
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
Payment Claims and Medical Records Data Sources
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:

Diabetic Retinopathy Payment Claims and Medical Records
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
Payment Claims and Medical Records Data Sources
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.

Eye Examinations includes self-response survey questions
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

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 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

 

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
Payment Claims and Medical Records Data Sources
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:

Glaucoma Payment Claims and Medical Records
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
Payment Claims and Medical Records Data Sources
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

Need for vision care includes self-response survey questions
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.

Vision Screening includes self-response survey questions
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:

Glaucoma screening
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
Payment Claims and Medical Records Data Sources
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:

Tests and Imaging Payment Claims and Medical Records
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
Payment Claims and Medical Records Data Sources
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.

Vision Correction includes self-response survey questions
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
Self-report Vision Rehabilitation, Devices and Protection Indicators
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
Self-report Use of Eye Protection
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