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92133

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đź©ş CPT Code 92133: Documentation & Billing Guide

Ophthalmic diagnostic imaging of the posterior segment using optical coherence tomography, with interpretation and report

đź©ş Short Definition

Scanning computerized ophthalmic diagnostic imaging of the posterior segment using optical coherence tomography with interpretation and report, unilateral or bilateral, optic nerve

Long Definition

CPT code 92133 describes computerized ophthalmic diagnostic imaging of the optic nerve head using optical coherence tomography technology. This non-invasive imaging modality provides high-resolution cross-sectional and three-dimensional images of the optic nerve, peripapillary retinal nerve fiber layer, and surrounding structures. The procedure is primarily utilized for glaucoma detection, diagnosis, and monitoring; evaluation of optic neuropathies; and assessment of optic disc abnormalities.

The code includes image acquisition, physician interpretation and report, and may be performed unilaterally or bilaterally with one unit billed regardless of laterality. This code specifically focuses on the optic nerve and cannot be billed in conjunction with 92134 (retina OCT) or 92137 (retina OCT with angiography) at the same patient encounter.

Area of Body

Optic nerve and surrounding structures including:

  • Optic nerve head (optic disc)

  • Peripapillary retinal nerve fiber layer (RNFL)

  • Neuroretinal rim

  • Optic cup and cup-to-disc ratio

  • Bruch’s membrane opening

  • Lamina cribrosa

  • Peripapillary choroid

  • Juxtapapillary retina

  • Optic nerve head blood vessels

Service Components

Included Services:

  • Image acquisition of optic nerve head

  • Peripapillary retinal nerve fiber layer thickness analysis

  • Circumpapillary scanning protocol

  • Technical component (equipment operation, image capture, quality assessment)

  • Professional component (physician interpretation and report)

  • Written report documenting findings and measurements

  • Bilateral imaging when performed (both eyes included in single unit)

  • Multiple scan patterns to optimize diagnostic information

  • Comparison to normative database

  • Comparison to prior examinations when available

  • Color-coded thickness maps and deviation maps

Excludes:

  • Retina OCT imaging (use 92134 for retina or 92137 for retina with OCT angiography)

  • Cannot bill 92133 and 92134 at same patient encounter per CPT instructions

  • Cannot bill 92133 and 92137 at same patient encounter

  • Anterior segment OCT (use 92132)

  • Fundus photography alone (92250) - may be bundled by NCCI

  • Extended ophthalmoscopy (92225-92226)

  • Visual field testing (92081-92083) - report separately

  • Optic nerve ultrasound (76516)

Includes:

  • RNFL thickness measurements in all quadrants

  • Cup-to-disc ratio assessment

  • Neuroretinal rim analysis

  • Deviation from age-matched normative database

  • Ganglion cell complex analysis when relevant to optic nerve

  • Asymmetry analysis between eyes

  • Progression analysis when baseline studies available

RVU Information

Work RVU (wRVU): 0.52
Facility Total RVU: Approximately 0.80
Non-Facility Total RVU: Approximately 1.39
Global Days: XXX (diagnostic test, no global period)
Medicare Status: Active/Payable
2026 Medicare National Average: Approximately $45-48 (varies by locality)

RVU Note: RVUs for OCT codes were revised and decreased in 2025. Prior to revision, total RVU was approximately 1.53. Code 92133 is designated as Designated Health Service under Stark Law effective 2025.

HCC Status

Not Applicable - HCC coding applies only to ICD-10 diagnosis codes, not CPT procedure codes. However, glaucoma diagnoses documented may have indirect HCC implications through related conditions.

Assistant Surgeon Status

Assistant Payable: No
CPT 92133 is a diagnostic imaging service, not a surgical procedure. Assistant surgeon modifiers (80, 81, 82, AS) are not applicable to diagnostic testing services and will not be reimbursed.

Common Modifiers

ModifierDescriptionUsage FrequencyApplication
26Professional component onlyModerateInterpretation without equipment ownership
TCTechnical component onlyModerateImage acquisition without interpretation
59Distinct procedural serviceLowRarely needed; possible with certain combinations
76Repeat procedure by same physicianLowMedically necessary repeat same day
77Repeat procedure by different physicianRareDifferent provider repeat imaging
52Reduced servicesRareIncomplete service
RTRight sideNot recommendedCode includes bilateral; generally not used
LTLeft sideNot recommendedCode includes bilateral; generally not used
GYStatutorily excludedLowNon-covered by Medicare
GAWaiver of liability on fileLowABN on file for non-covered service
GZExpected denialLowItem/service expected to be denied

Common Associated CPT Codes

CPT CodeDescriptionClinical ContextBilling Relationship
92083Visual field examination, extendedglaucoma evaluation/monitoringCommonly billed together, separately payable
92002Intermediate eye exam, new patientInitial glaucoma evaluationSame encounter typical
92004Comprehensive eye exam, new patientNew patient complete evaluationSame encounter typical
92012Intermediate eye exam, establishedFollow-up visitsCommonly paired
92014Comprehensive eye exam, establishedAnnual comprehensive examCommonly paired
92250Fundus photographyDocumentation of disc appearanceMay be bundled by NCCI
92132OCT anterior segmentAngle assessment in glaucomaSeparately billable same day
92020GonioscopyGlaucoma angle evaluationSeparately billable
92081Visual field, limitedBasic field testingLess commonly paired
92082Visual field, intermediateAlternative field testingLess commonly paired
92100Serial tonometryDiurnal curve for glaucomaOccasionally paired
67145Prophylaxis retinal detachmentIncidental optic findingsDifferent encounter typically
65855Trabeculoplasty laser surgeryGlaucoma treatmentPre/post-procedure imaging
66170-66172Trabeculectomy variationsGlaucoma surgeryPre/post-op assessment
66174-66183MIGS proceduresMinimally invasive glaucoma surgeryPre/post-op monitoring
66850Cataract surgeryCombined cataract-glaucoma casesPre-op evaluation
0621T-0622TTrabeculostomy proceduresNovel glaucoma proceduresPre/post-op imaging

Code Tree/Hierarchy

CPT Manual Section: Medicine (90000-99999)
Subsection: Ophthalmology (92002-92499)
Major Category: Special Ophthalmological Services (92018-92499)
Subcategory: Other Specialized Services (92065-92145)
Service Type: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Specific Focus: Posterior Segment - Optic Nerve

Code Family Structure:

Scanning Computerized Ophthalmic Diagnostic Imaging 
├── Anterior Segment │   
└── 92132 (Anterior segment OCT) 
└── Posterior Segment     
	├── 92133 (Optic nerve) ◄ Current Code    
	├── 92134 (Retina) - MUTUALLY EXCLUSIVE same encounter    
	└── 92137 (Retina with OCTA) - MUTUALLY EXCLUSIVE same encounter

Key Relationships:

  • Cannot bill 92133 + 92134 same encounter

  • Cannot bill 92133 + 92137 same encounter

  • Can bill 92133 + 92132 same encounter (anterior + posterior)

  • Can bill 92133 + examination codes same encounter

  • Can bill 92133 + visual field testing same encounter

Coding Examples

Example 1: Glaucoma Suspect with Elevated IOP

Clinical Scenario: 65-year-old African American male referred by optometrist for elevated IOP 26 mmHg OU and suspicious optic nerves with asymmetric cupping.

History: Family history of glaucoma (mother), no prior glaucoma evaluation. Denies visual changes.

Examination Findings:

  • Visual acuity: 20/20 OU

  • IOP: 25 mmHg OD, 27 mmHg OS

  • Gonioscopy: Open angles 360 degrees OU

  • Optic disc exam: CDR 0.6 OD, 0.75 OS with inferior rim thinning OS

  • No other ocular pathology

Testing Performed:

  • OCT optic nerve: RNFL thickness OD 82 microns average (low normal), OS 68 microns (abnormal) with inferior thinning to 55 microns

  • Visual field testing: Reliable, within normal limits both eyes

Coding:

  • 92004 - Comprehensive ophthalmological examination, new patient

  • 92133 - OCT optic nerve

  • 92083 - Visual field examination, extended

  • 92020 - Gonioscopy (separate procedure)

  • H40.001 - Preglaucoma, unspecified, right eye

  • H40.002 - Preglaucoma, unspecified, left eye

  • Z82.71 - Family history of glaucoma

Medical Necessity: High-risk patient with elevated IOP, family history, and asymmetric optic nerve cupping requires baseline structural imaging to establish diagnosis and monitor for progression.

Example 2: Primary Open-Angle Glaucoma Monitoring

Clinical Scenario: 58-year-old female with known POAG on latanoprost OU, presents for 6-month follow-up.

History: Diagnosed POAG 3 years ago, compliant with drops, no visual complaints.

Examination:

  • Visual acuity: 20/25 OU

  • IOP: 14 mmHg OD, 15 mmHg OS (target <15)

  • Lens: early nuclear sclerotic cataracts

  • Optic nerves: CDR 0.7 OU, stable appearance

Testing:

  • OCT optic nerve: Comparison to baseline 18 months ago shows stable RNFL thickness; average RNFL 68 microns OD, 72 microns OS; no significant change from prior

  • Visual field: Stable baseline defects, no progression

Coding:

  • 92014 - Comprehensive ophthalmological examination, established patient

  • 92133 - OCT optic nerve

  • 92083 - Visual field examination

  • H40.1113 - Primary open-angle glaucoma, bilateral, moderate stage

  • Z79.899 - Long-term use of other medications (for latanoprost documentation)

Medical Necessity: Established glaucoma requires periodic structural and functional monitoring to detect progression and guide treatment decisions.

Example 3: Optic Neuritis Evaluation

Clinical Scenario: 32-year-old female with sudden onset decreased vision and pain with eye movement right eye over 3 days. No prior ocular history.

History: Reports central vision blur and color desaturation. History of numbness/tingling in legs 2 years ago, undiagnosed.

Examination:

  • Visual acuity: 20/80 OD, 20/20 OS

  • RAPD: 3+ right eye

  • Color vision: Reduced red saturation OD

  • Optic disc: Mild hyperemia OD, normal OS

  • No cells/flare in anterior chamber or vitreous

Testing:

  • OCT optic nerve: Mild peripapillary RNFL thickening OD consistent with disc edema; average RNFL 118 microns OD (elevated), 95 microns OS (normal); increased thickness all quadrants OD

Coding:

  • 92004 - Comprehensive examination, new patient

  • 92133 - OCT optic nerve

  • H46.11 - Optic neuritis, right eye

  • Possibly H46.12 if fellow eye shows subclinical findings

Additional coding considerations:

  • Would typically order MRI brain and orbits with contrast

  • May code for color vision testing if separately documented

  • Visual field may show central scotoma

Medical Necessity: Acute optic neuropathy requires detailed optic nerve imaging to confirm disc edema, establish baseline, and monitor treatment response and recovery.

Example 4: Papilledema from Increased Intracranial Pressure

Clinical Scenario: 28-year-old obese female with headaches referred from ER with bilateral disc swelling on funduscopic exam. ER imaging showed no mass; LP opening pressure 38 cm H2O.

Examination:

  • Visual acuity: 20/25 OU

  • No RAPD

  • Dilated exam: Bilateral optic disc elevation with blurred margins, peripapillary hemorrhages, no macular star

Testing:

  • OCT optic nerve: Marked RNFL thickening OU; average RNFL 165 microns OD, 172 microns OS (severely elevated); disc elevation 450 microns OD, 490 microns OS

  • Visual field: Enlarged blind spots bilaterally

Coding:

  • 92004 or 92014 - Examination depending on new vs established

  • 92133 - OCT optic nerve (critical for baseline and monitoring)

  • 92083 - Visual field

  • H47.11 - Papilledema, unspecified

  • G93.2 - Benign intracranial hypertension (if diagnosed)

  • E66.xx - Overweight and obesity codes if relevant

Medical Necessity: Papilledema requires accurate baseline measurement of disc elevation and RNFL thickness to monitor treatment response and prevent permanent vision loss. Serial OCT essential for management.

Example 5: Glaucoma Progression Detection

Clinical Scenario: 71-year-old male with advanced POAG on maximum medical therapy, last OCT 12 months ago.

History: Long-standing glaucoma, compliant with four medications, concerned about worsening peripheral vision.

Examination:

  • Visual acuity: 20/30 OU

  • IOP: 18 mmHg OD, 19 mmHg OS

  • Advanced glaucomatous cupping: CDR 0.9 OU with only thin temporal rim remaining

Testing:

  • OCT optic nerve: Comparison to prior shows significant thinning of remaining temporal RNFL OD from 52 to 43 microns; global RNFL now 48 microns OD (was 54), 45 microns OS (was 47); progression analysis software flags “possible progression”

  • Visual field: Worsening of superior arcuate defect OD

Assessment: Progressing glaucoma despite medications; discuss filtration surgery

Coding:

  • 92014 - Comprehensive examination, established

  • 92133 - OCT optic nerve with progression analysis

  • 92083 - Visual field

  • H40.1114 - Primary open-angle glaucoma, bilateral, severe stage

  • Modifier 57 on exam if decision for surgery made

Medical Necessity: Detecting progression in glaucoma patients is critical for determining when to escalate treatment from medical to surgical therapy.

Example 6: Tilted Disc Syndrome vs Glaucoma

Clinical Scenario: 24-year-old myopic female referred for abnormal optic nerves found on routine exam, ? glaucoma.

History: High myopia -8.00 D OU, no symptoms, no family history glaucoma.

Examination:

  • Visual acuity: 20/20 OU with correction

  • IOP: 14 mmHg OU

  • Optic discs: Oblique insertion, tilted appearance, inferonasal crescent, situs inversus

Testing:

  • OCT optic nerve: Demonstrates tilted disc anatomy with oblique insertion; RNFL thickness shows inferior thinning that matches anatomic tilt rather than glaucomatous pattern; average RNFL 88 microns OU

  • Visual field: Superior temporal defects corresponding to inferior crescent, stable

Coding:

  • 92004 - Comprehensive examination, new patient

  • 92133 - OCT optic nerve

  • 92083 - Visual field

  • H47.13 - Optic nerve hypoplasia (if applicable)

  • Q14.2 - Congenital malformation of optic disc

  • H44.20 - Degenerative myopia, unspecified eye

Medical Necessity: Differentiate congenital optic nerve anomaly from glaucoma; establish baseline for future comparison since tilted discs can develop glaucoma.

Documentation Requirements

Comprehensive documentation supporting CPT 92133 must include:

Medical Necessity Statement:

  • Clinical indication for optic nerve imaging

  • Signs, symptoms, or conditions prompting the test

  • How results will impact diagnosis or treatment decisions

  • Risk factors supporting need for testing

Complete Interpretation Report:

Patient Demographics:

  • Patient name, date of birth, medical record number

  • Date of service

  • Ordering physician

Technical Quality:

  • Signal strength or quality indicator

  • Adequacy of scan quality

  • Any limitations affecting interpretation

Quantitative Measurements (Required):

  • Average RNFL thickness (both eyes if bilateral)

  • Quadrant RNFL thickness (superior, inferior, nasal, temporal)

  • Clock-hour RNFL thickness measurements

  • Cup-to-disc ratio (horizontal and vertical)

  • Disc area, cup area, rim area

  • Comparison to normative database (specify percentiles or classification)

Qualitative Findings:

  • Optic disc morphology and appearance

  • Neuroretinal rim characteristics

  • Peripapillary changes

  • Vascular abnormalities

  • Hemorrhages if present

  • Any other structural abnormalities

Comparison Studies:

  • Comparison to prior examinations with dates

  • Statement of stability or change

  • Trend analysis or progression assessment when applicable

  • Percentage change in key parameters

Color-Coded Maps:

  • Reference to RNFL thickness map

  • Deviation map interpretation

  • Asymmetry analysis between eyes

Clinical Correlation:

  • Correlation with clinical examination findings

  • Correlation with visual field results if available

  • Assessment of consistency with presumed diagnosis

Impression/Conclusion:

  • Summary of key findings

  • Classification (normal, borderline, abnormal)

  • Recommendations for follow-up timing

  • Clinical implications

Signature:

  • Physician signature with date

  • Credentials and specialty

Image Storage:

  • Digital images stored in PACS or EMR system

  • Key representative images attached to report

  • Raw data retained per medical record retention requirements

Billing Guidelines and Best Practices

Critical Billing Rules:

Unilateral vs Bilateral:

  • Bill one unit regardless of whether one or both eyes imaged

  • Do NOT use modifier 50 (bilateral procedure)

  • Do NOT bill separately with RT and LT modifiers

  • Quantity field should always be “1”

  • This is per-encounter billing, not per-eye

Mutually Exclusive Codes - Same Encounter Prohibition:

  • Cannot bill 92133 and 92134 together same day

  • Cannot bill 92133 and 92137 together same day

  • NCCI bundles 92134 into 92133 (column 1/column 2 edit)

  • No modifier will bypass this edit for same encounter

  • If both optic nerve and retina imaging needed, choose most appropriate code based on primary reason for imaging

  • May bill on separate dates if medically necessary

Can Bill Together Same Encounter:

  • 92133 + 92132 (anterior segment OCT) - separately payable

  • 92133 + examination codes (92002-92014) - separately payable

  • 92133 + visual field testing (92081-92083) - separately payable, clinically appropriate

  • 92133 + gonioscopy (92020) - separately payable

Fundus Photography Considerations:

  • NCCI may bundle 92250 (fundus photography) with 92133

  • Some payers allow both with modifier or documentation of medical necessity

  • Document distinct clinical purpose if billing both

Professional vs Technical Component Billing:

  • Global code includes both components

  • Modifier 26 for professional component (interpretation only)

  • Modifier TC for technical component (image acquisition only)

  • Must have equipment ownership for TC billing

  • Split billing common in hospital or facility settings

Frequency Limitations:

  • No specific Medicare frequency limit, but medical necessity required

  • Typical monitoring intervals:

    • Glaucoma suspects: 12-24 months

    • Stable glaucoma: 6-12 months

    • Progressing or advanced glaucoma: 3-6 months

    • Optic neuropathies: Variable based on condition

  • Document reason if more frequent than expected

  • Commercial payers may have specific frequency edits

Medical Necessity Requirements:

  • Must support with appropriate diagnosis code

  • Routine screening without symptoms/findings typically not covered

  • Document risk factors, clinical findings, or symptoms supporting test

  • Prior authorization may be required by some payers

Designated Health Services (DHS) - Stark Law:

  • CPT 92133 added to Stark Law DHS list in 2025

  • Physicians with ownership in OCT equipment must comply with Stark exceptions

  • Affects productivity-based compensation arrangements

  • Self-referral restrictions apply

  • Consult compliance officer for physician-owned practices

Medicare Local Coverage Determinations:

  • Check your MAC for any LCD covering OCT services

  • Common LCD requirements:

    • Covered diagnoses specified

    • Frequency limitations

    • Documentation requirements

  • MACs may require supporting documentation for certain diagnoses

Prior Authorization:

  • Some commercial payers require prior auth

  • Medicare generally does not require prior auth for 92133

  • Medicare Advantage plans may have prior auth requirements

  • Verify coverage before performing test for non-Medicare patients

Advanced Beneficiary Notice (ABN):

  • Provide ABN if patient is Medicare beneficiary and coverage in doubt

  • Common scenarios requiring ABN:

    • Frequency exceeded

    • Diagnosis may not be covered

    • Screening without medical necessity

  • Use GA modifier when ABN obtained and patient agrees to pay

  • Use GZ modifier if ABN not obtained but service expected to deny

Documentation Red Flags:

  • Generic or template reports without patient-specific findings

  • Missing quantitative measurements

  • No physician signature or credentials

  • Billing for both eyes separately (incorrect per-eye billing)

  • Billing 92133 and 92134 same encounter

  • Using inappropriate modifiers (50, RT, LT incorrectly)

  • Inadequate medical necessity documentation

  • Frequency exceeding clinical standards without justification

Audit Considerations:

  • OCT codes under increased scrutiny by MACs and auditors

  • Documentation must clearly support medical necessity

  • Interpretation must be individualized, not template-based

  • Comparison to prior studies should be specific, not generic

  • Be prepared to demonstrate clinical decision-making based on results

Clinical Indications for 92133

Glaucoma-Related (Most Common):

  • H40.001-H40.009 - Preglaucoma, unspecified (glaucoma suspect)

  • H40.00x1-H40.00x4 - Preglaucoma with staging

  • H40.05x - Ocular hypertension

  • H40.06x - Primary angle closure suspect

  • H40.10x - Primary open-angle glaucoma (all stages)

  • H40.11x - Primary open-angle glaucoma, low-tension variant

  • H40.12x - Low-tension glaucoma

  • H40.13x - Pigmentary glaucoma

  • H40.14x - Capsular glaucoma with pseudoexfoliation

  • H40.15x - Residual stage of open-angle glaucoma

  • H40.20x - Primary angle-closure glaucoma (all stages)

  • H40.30x - Glaucoma secondary to eye trauma

  • H40.31x - Glaucoma secondary to eye inflammation

  • H40.32x - Glaucoma secondary to other eye disorders

  • H40.33x - Aqueous misdirection glaucoma

  • H40.40x - Glaucoma secondary to drugs

  • H40.5x - Glaucoma secondary to other eye disorders

  • H40.6x - Glaucoma secondary to drugs

  • H40.811-H40.83x - Other specified glaucoma types

  • H42 - Glaucoma in diseases classified elsewhere

  • Z82.71 - Family history of glaucoma

Optic Nerve Pathology:

  • H46.x - Optic neuritis (all types)

  • H47.011-H47.019 - Ischemic optic neuropathy

  • H47.021-H47.029 - Hemorrhage in optic nerve sheaths

  • H47.031-H47.039 - Optic nerve hypoplasia

  • H47.091-H47.099 - Other disorders of optic nerve

  • H47.10-H47.149 - Papilledema

  • H47.20-H47.293 - Optic atrophy

  • H47.311-H47.319 - Coloboma of optic disc

  • H47.321-H47.329 - Drusen of optic disc

  • H47.331-H47.339 - Pseudopapilledema

  • H47.391-H47.399 - Other disorders of optic disc

Congenital/Developmental:

  • Q14.2 - Congenital malformation of optic disc

  • Q14.8 - Other congenital malformations of posterior segment

Systemic Diseases Affecting Optic Nerve:

  • E08-E13.3x - Diabetes with ophthalmic complications (diabetic papillopathy)

  • I67.4 - Hypertensive encephalopathy (may cause papilledema)

  • G93.2 - Benign intracranial hypertension (idiopathic intracranial hypertension)

  • Demyelinating diseases in appropriate clinical context

High-Risk Factors Supporting Testing:

  • Z82.71 - Family history of glaucoma

  • H44.2x - Degenerative myopia (increased glaucoma risk)

  • Advanced age

  • African ancestry (higher glaucoma risk)

  • Z98.89 - Post-surgical states (post-glaucoma surgery monitoring)

Graph View

Recent Notes