• Retina Codes


    Comparison 2020 & 2021 Payments — Office

    Reimbursements for evaluation and management (E/M) services are scheduled to change Jan. 1, 2021. The Academy has estimated the effect the cuts will have on reimbursements, both to hospital facilities and to physician practices.

    Facility payments are made for services provided in a hospital outpatient department or ambulatory surgery center. These are predicted averages across the U.S. Specific values will vary slightly.

     
    CPT Code Descriptor 2020 Office Pay 2021 Office Pay Change in Office Pay 2020-21 % Change in Office Pay 2020-21
    67028 Intravitreal injection $103.22 $105.49 $2.28 2.2%
    67105 RD repair; photocoagulation $303.15 $278.41 -$24.74 -8.2%
    67110 RD repair by inj of air/gas $906.21 $836.84 -$69.37 -7.7%
    67141 Prophylaxis of RD, cryotherapy $535.93 $491.65 -$44.28 -8.3%
    67145 Prophylaxis of RD, photocoagulation $539.54 $493.59 -$45.95 -8.5%
    67210 Destruction of retinal lesion $528.71 $482.94 -$45.77 -8.7%
    67220 Destruction of choroidal lesion $544.59 $498.10 -$46.49 -8.5%
    67228 Treat. of extensive retinopathy $348.99 $317.77 -$31.22 -8.9%
    92002 Eye visit, new pt, intermediate $85.53 $80.97 -$4.56 -5.3%
    92004 Eye visit, new pt, comp ophth $152.66 $141.30 -$11.36 -7.4%
    92012 Eye visit, est pt, intermediate $89.86 $84.20 -$5.66 -6.3%
    92014 Eye visit, est pt, comp ophth $128.12 $119.04 -$9.08 -7.1%
    92134 SCODI retina $41.50 $38.39 -$3.11 -7.5%
    92201 EO w/ retinal drawing & scleral depress $25.62 $23.23 -$2.39 -9.3%
    92202 EO w/ optic nerve or macula drawing $16.24 $14.52 -$1.72 -10.6%
    99204 E/M, new pt, mod, 45-59 mins $167.09 $159.37 -$7.73 -4.6%
    99205 E/M, new pt, high, 60-74 mins $211.12 $210.66 -$0.46 -0.2%
    99214 E/M, est pt, mod, 30-39 mins $110.43 $122.91 $12.48 11.3%
    99215 E/M, est pt, high, 40-54 mins $148.33 $172.27 $23.94 16.1%
    92250 Fundus photography $45.83 $36.78 -$9.06 -19.8%
    92235 Fluorescein angiography $105.74 $111.62 $5.88 5.6%

    Comparison 2020 & 2021 Payments — Facility

    CPT Code Descriptor 2020 Facility Pay 2021 Facility Pay Change in Facility Pay 2020-21 % Change in Facility Pay 2020-21
    67028 Intravitreal injection $100.69 $85.17 -$15.52 -15.4%
    67036 Vitrectomy $918.12 $833.29 -$84.83 -9.2%
    67040 Vitrectomy w/ endolaser photocoag $1,062.48 $962.01 -$100.47 -9.5%
    67105 RD repair; photocoagulation $280.42 $255.83 -$24.59 -8.8%
    67108 RD repair with vitrectomy $1,222.35 $1,103.95 -$118.40 -9.7%
    67110 RD repair by inj of air/gas $829.70 $756.83 -$72.87 -8.8%
    67141 Prophylaxis of RD, cryotherapy $496.23 $451.65 -$44.59 -9.0%
    67145 Prophylaxis of RD, photocoagulation $507.06 $461.00 -$46.06 -9.1%
    67210 Destruction of retinal lesion $509.59 $463.26 -$46.32 -9.1%
    67220 Destruction of choroidal lesion $509.59 $463.26 -$46.32 -9.1%
    67228 Treat. of extensive retinopathy $311.81 $281.31 -$30.50 -9.8%
    92002 Eye visit, new pt, intermediate $48.36 $43.23 -$5.13 -10.6%
    92004 Eye visit, new pt, comp ophth $99.97 $88.72 -$11.25 -11.3%
    92012 Eye visit, est pt, intermediate $53.05 $47.10 -$5.95 -11.2%
    92014 Eye visit, est pt, comp ophth $80.48 $71.30 -$9.18 -11.4%
    92201 EO w/ retinal drawing & scleral depress $23.46 $20.97 -$2.49 -10.6%
    92202 EO w/ optic nerve or macula drawing $15.16 $13.55 -$1.61 -10.6%
    99204 E/M, new pt, mod, 45-59 mins $132.09 $127.75 -$4.34 -3.3%
    99205 E/M, new pt, high, 60-74 mins $172.51 $173.88 $1.38 0.8%
    99214 E/M, est pt, mod, 30-39 mins $80.48 $93.23 $12.75 15.8%
    99215 E/M, est pt, high, 40-54 mins $113.68 $137.75 $24.07 21.2%