MAY 08, 2023
Is dilation required?
For Eye visit codes, if the physician documents 12 exam elements on an established patient, but doesn't dilate, do we bill a 92012 or 92014?Answer:
Who is the payer? The requirement for dilation is payer dependent. While the CPT guidance uses the term “may include” some payers and state specific guidelines have their own dilation requirements. We have encountered numerous policies that specify dilation is required and auditors requiring dilation for comprehensive Eye visit codes.
The Academy recommends for comprehensive Eye visit codes
to perform all 12 exam elements and dilation unless contraindicated.