Eye Exams
Vision Care Services
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 Service
The National Health Interview Survey (NHIS) includes questions indicating whether a person had an eye exam.
| Survey | Description | Question Text | Variable name(s) | Sample | Response options |
|---|---|---|---|---|---|
| NHIS – Child Module | Percentage of children whose family members talked to an optometrist, optician, or eye doctor (someone who prescribes eyeglasses) about the child’s health (NHIS Child Module) | 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?
An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)? |
CHCSYR_2 CHCSYR2 |
Ages 0-17 | 1 Yes, 2 No, 7 Refused, 9 Don’t know |
| NHIS – Adult module | Percentage of adults who in the past 12 months have seen or talked to an optometrist, optician, or eye doctor (someone who prescribes eyeglasses) about their own health (NHIS Adult Module) | DURING THE PAST 12 MONTHS, have you seen or talked to any of the following health care providers about your own health?
An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)? |
AHCSY1_2 AHCSYR2 |
Ages 18+ | 1 Yes, 2 No, 7 Refused, 9 Don’t know |
Explore Data in the VEHSS Application
The data sources available for this category include NHIS and NSCH. See data source documentation.
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.
| 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 |
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 |
Explore Data in the VEHSS Application
The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, Managed Vision Care, and MarketScan commercial insurance claims. See data source documentation.