92260

⚕️CPT 92260 - Ophthalmodynamometry

Full Descriptor: Ophthalmodynamometry

(AKA: Determination of retinal arterial pressure; measurement of blood pressure within the central retinal artery via direct ophthalmoscopic observation during controlled ocular pressure application)

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🔬 Procedure Overview

Ophthalmodynamometry (ODM) is a diagnostic ophthalmic procedure used to measure the diastolic and systolic blood pressure within the central retinal artery (CRA), the primary arterial supply of the inner retina. This measurement provides critical insight into the hemodynamic status of the ophthalmic circulation, which reflects upstream vascular conditions in the internal carotid artery and ophthalmic artery systems.

The procedure is performed using a Baillart ophthalmodynamometer (or equivalent device), which is gently pressed against the patient’s cornea or sclera. The examiner simultaneously views the fundus through a direct ophthalmoscope and incrementally increases the pressure applied to the globe. The physician notes two key endpoints:

Measurement	Definition	Clinical Meaning
Diastolic ODM	Lowest pressure at which the central retinal artery begins to pulsate	Indicates perfusion pressure at rest
Systolic ODM	Pressure at which retinal arterial pulsation ceases entirely	Indicates maximum CRA pressure required to stop flow

These measurements are then compared between both eyes and correlated with the patient’s brachial blood pressure. A significant asymmetry (≥20% difference) between eyes suggests ipsilateral internal carotid artery stenosis or occlusion — making ODM a valuable, non-invasive screening tool for hemodynamically significant carotid artery disease in the ophthalmic neurology and vascular ophthalmology setting.

Although ODM has largely been supplemented in practice by Doppler ultrasound and angiographic studies, it remains a billable and clinically valid procedure when appropriately documented and medically indicated.

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📋 Code Details

Field	Detail
CPT Code	92260
Full Descriptor	Ophthalmodynamometry
Category	Medicine - Special Ophthalmological Services and Procedures
Subcategory	Ophthalmoscopy Procedures (92201-92260)
Global Period	XXX (global surgery concept does not apply; diagnostic service)
wRVU	0.50 (historically stable; subject to 2026 CMS 2.5% efficiency adjustment for non-time-based codes)
Medicare Reimbursement (National Avg)	~$16-$22 (non-facility); locality-dependent — verify via CMS MPFS tool
Bilateral Indicator	1 - 150% allowable when performed bilaterally
Assistant Surgeon Payable	❌ No
Bilateral Billing	✅ Yes - use modifier -50 or -RT/-LT; bill at 150% when performed bilaterally
Technical Component Billable	✅ Yes - modifier -TC
Professional Component Billable	✅ Yes - modifier -26
Place of Service	Office (11), Outpatient Hospital (22), Independent Clinic (49), FQHC (50), RHC (72)
Telehealth	❌ No - requires physical contact with the patient’s eye

⚠️ 2026 RVU Note: The CMS 2026 MPFS Final Rule applied a -2.5% efficiency adjustment to existing non-time-based services. This affects the work RVU for 92260, though given its already low wRVU base of 0.50, the impact is minimal in absolute dollar terms. Always verify your current locality-specific rate using the CMS Physician Fee Schedule look-up tool.

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✅ What Is Included (Bundled Into 92260)

The following components are integral to 92260 and cannot be separately billed:

• Use of the ophthalmodynamometer instrument
• Topical anesthetic eye drops (if used for patient comfort during globe compression)
• Ophthalmoscopic visualization of the central retinal artery during pressure application
• Identification of diastolic and systolic endpoint measurements
• Bilateral comparison of CRA pressures (when both eyes examined)
• Physician interpretation of results
• Documentation of findings in the medical record

📌 The dye, IV access, or imaging technology is not part of this procedure — those belong to angiography codes. 92260 is a contact pressure/observation procedure only.

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🚫 Excludes / Do Not Report Together

Code	Description	Note
92250	Fundus photography	If performed, bill separately only when clearly distinct and separately documented
92134	OCT of retina	Separate procedure; may be billed same day with appropriate documentation
92235	Fluorescein angiography	Separate procedure; different clinical intent
92240	ICG angiography	Separate procedure; different clinical intent
92004 / 92014	Comprehensive ophthalmological examination	If 92260 is performed as part of a comprehensive exam, confirm it is medically distinct and separately documented; many payers may bundle into the E/M/exam code
Tonometry alone	92100	Tonometry measures IOP (intraocular pressure); ODM measures retinal arterial pressure — these are distinct measurements and distinct codes

⚠️ Critical Distinction: Do not confuse 92260 (ophthalmodynamometry — retinal arterial blood pressure) with tonometry codes such as 92100 (serial tonometry). Tonometry measures intraocular pressure (IOP) in the context of glaucoma. ODM measures retinal arterial perfusion pressure in the context of vascular disease. They assess different physiologic parameters and cannot be substituted for one another.

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🧩 Code Tree / Related Codes

Special Ophthalmological Services and Procedures - Ophthalmoscopy (CPT 92201-92260) │ ├── 92201 - Ophthalmoscopy, extended; with retinal drawing and scleral depression, initial ├── 92202 - Ophthalmoscopy, extended; with retinal drawing and scleral depression, subsequent ├── 92225 - Ophthalmoscopy, extended; with retinal drawing, initial ├── 92226 - Ophthalmoscopy, extended; with retinal drawing, subsequent ├── 92227 - Imaging of retina for detection or monitoring, unilateral or bilateral (remote) ├── 92228 - Imaging of retina, remote physician interpretation, low complexity ├── 92229 - Imaging of retina, point-of-care autonomous analysis ├── 92230 - Fluorescein angioscopy with interpretation and report ├── 92235 - Fluorescein angiography (FA) with interpretation and report ├── 92240 - Indocyanine-green (ICG) angiography with interpretation and report ├── 92242 - FA + ICG angiography performed at same encounter ├── 92250 - Fundus photography with interpretation and report ├── 92260 - Ophthalmodynamometry ← YOU ARE HERE │ └── Related Functional/Vascular Codes ├── 92100 - Serial tonometry (IOP; distinct from ODM) ├── 93880 - Carotid duplex scan, bilateral (often ordered alongside ODM for carotid evaluation) └── 0198T - Measurement of ocular blood flow by repetitive IOP sampling (investigational)

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🏷️ Applicable Modifiers

Modifier	Name	When to Use with 92260
-26	Professional Component	Physician interprets only; facility owns and operates equipment
-TC	Technical Component	Facility performs procedure; physician bills -26 separately
-RT	Right Side	Procedure performed on right eye only
-LT	Left Side	Procedure performed on left eye only
-50	Bilateral Procedure	Both eyes examined at same encounter; bill at 150% of single allowable
-59	Distinct Procedural Service	Used if 92260 is clearly distinct from another same-day service (e.g., comprehensive exam)
-76	Repeat Procedure - Same Physician	Same physician repeats ODM same day (rare but possible in monitoring context)
-77	Repeat Procedure - Different Physician	Different physician repeats ODM same day
-22	Increased Procedural Services	Substantially greater work required (unusual for ODM; use with caution and strong documentation)
-GY	Item/Service Statutorily Excluded	Non-covered service; no ABN available or intentional exclusion
-GA	Waiver of Liability Statement on File	ABN signed and on file; potential Medicare non-coverage anticipated

Tip

💡 Bilateral Billing Tip: 92260 has a bilateral indicator of 1, meaning when performed bilaterally, you should bill with modifier -50 (or with -RT on one line and -LT on a second line, depending on payer preference) at 150% of the allowable — not 200%. This differs from codes with a bilateral indicator of 0, which are flat-fee regardless of bilateral performance. Verify your payer’s specific billing preference for bilateral ophthalmology diagnostic codes.

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🩺 ICD-10-CM Codes That Support Medical Necessity

The following ICD-10-CM diagnoses represent the primary clinical indications for 92260. The procedure is most defensible when documentation specifically supports evaluation of retinal arterial perfusion pressure in the context of vascular, neurological, or ocular hemodynamic disease.

Retinal Artery Occlusions

ICD-10 Code	Description	HCC
H34.10	Central retinal artery occlusion, unspecified eye	—
H34.11	Central retinal artery occlusion, right eye	—
H34.12	Central retinal artery occlusion, left eye	—
H34.13	Central retinal artery occlusion, bilateral	—
H34.00	Transient retinal artery occlusion, unspecified eye	—
H34.01	Transient retinal artery occlusion, right eye	—
H34.02	Transient retinal artery occlusion, left eye	—
H34.231	Tributary (branch) retinal artery occlusion, right eye	—
H34.232	Tributary (branch) retinal artery occlusion, left eye	—

📌 HCC Note: Retinal artery occlusion codes under H34.- do not currently map to a CMS-HCC risk adjustment category on their own. However, they frequently co-occur with codes that do carry HCC weight (e.g., hypertension, diabetes, atrial fibrillation), and those secondary diagnoses should always be captured and coded.

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Carotid Artery Disease / Vascular Insufficiency

ICD-10 Code	Description	HCC
I65.21	Occlusion and stenosis of right carotid artery	✅ HCC 108
I65.22	Occlusion and stenosis of left carotid artery	✅ HCC 108
I65.23	Occlusion and stenosis of bilateral carotid arteries	✅ HCC 108
I65.29	Occlusion and stenosis of other vertebral artery	✅ HCC 108
I67.2	Cerebral atherosclerosis	✅ HCC 108
I70.0	Atherosclerosis of aorta	✅ HCC 108

📌 HCC Note: Carotid and cerebrovascular occlusion/stenosis codes (I65.-) map to HCC 108 (Vascular Disease) in the CMS-HCC model, carrying a meaningful risk adjustment factor. Accurate capture of these upstream vascular diagnoses in ophthalmology visits — when documented — significantly impacts risk-adjusted payment and quality metrics.

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Ocular Hypertension and Glaucoma

ICD-10 Code	Description	HCC
H40.051	Ocular hypertension, right eye	—
H40.052	Ocular hypertension, left eye	—
H40.053	Ocular hypertension, bilateral	—
H40.10X0	Unspecified open-angle glaucoma, stage unspecified	—
H40.1110	Primary open-angle glaucoma, right eye, stage unspecified	—
H40.1120	Primary open-angle glaucoma, left eye, stage unspecified	—
H40.1122	Primary open-angle glaucoma, left eye, moderate stage	—
H40.1222	Low-tension glaucoma, left eye, moderate stage	—
H40.221	Chronic angle-closure glaucoma, right eye	—

📌 HCC Note: Glaucoma codes (H40.-) do not currently map to CMS-HCC risk adjustment categories. However, they represent valid medical necessity for ODM when the provider is specifically evaluating whether low ocular perfusion pressure is contributing to glaucomatous damage — a clinically important distinction in normal-tension glaucoma.

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Optic Nerve Disorders

ICD-10 Code	Description	HCC
H47.011	Ischemic optic neuropathy, right eye	—
H47.012	Ischemic optic neuropathy, left eye	—
H47.013	Ischemic optic neuropathy, bilateral	—
H47.321	Drusen of optic disc, right eye	—
H47.322	Drusen of optic disc, left eye	—

📌 Clinical Note: Ischemic optic neuropathy (H47.011-H47.013) is one of the most clinically compelling indications for ODM, as the procedure helps evaluate whether decreased perfusion pressure to the optic nerve head is contributing to ischemic damage. These codes do not carry HCC weight independently but are critical to establishing medical necessity.

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Retinal Vascular Disease (Additional Indications)

ICD-10 Code	Description	HCC
H34.8110	Central retinal vein occlusion, right eye, with macular edema	—
H34.8120	Central retinal vein occlusion, left eye, with macular edema	—
H35.051	Retinal neovascularization, unspecified, right eye	—
H35.052	Retinal neovascularization, unspecified, left eye	—
H35.061	Retinal vasculitis, right eye	—
H35.062	Retinal vasculitis, left eye	—

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Neurological / Systemic Conditions With Ocular Vascular Impact

ICD-10 Code	Description	HCC
G45.3	Amaurosis fugax	✅ HCC 107
G45.9	Transient cerebral ischemic attack, unspecified	✅ HCC 107
I10	Essential (primary) hypertension	✅ HCC 85 (in some models)
I73.9	Peripheral vascular disease, unspecified	✅ HCC 108

📌 HCC Note:

• G45.3 Amaurosis fugax → HCC 107 (Vascular Disease with Complications) — this is one of the strongest clinical links to 92260, as amaurosis fugax is caused by a transient retinal artery embolism and ODM is used to assess residual CRA perfusion pressure asymmetry suggesting upstream carotid stenosis.
• I10 Hypertension → maps to HCC 85 in some HCC model versions; always capture alongside the primary ocular condition.

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🏥 MS-DRG Applicability

MS-DRG: ❌ Not directly applicable.

CPT 92260 is a diagnostic, outpatient-only procedure billed under the Medicare Physician Fee Schedule (Part B) or HOPD/clinic fee schedules. It does not independently drive inpatient MS-DRG assignment. However, when a patient is admitted inpatient and the underlying diagnoses that warranted ophthalmodynamometry (e.g., I65.21 carotid stenosis, G45.3 amaurosis fugax, H34.11 central retinal artery occlusion) are present as principal or secondary diagnoses, those ICD-10-CM codes will factor into MS-DRG grouping for the inpatient claim. Particularly, diagnoses like I65.21-I65.23 and G45.3 may map to neurovascular MS-DRGs (034-039 range) when the patient is admitted for TIA, cerebrovascular disease, or carotid evaluation.

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💡 Coding Examples

Example 1 - Unilateral ODM in Office (Right Eye, Global Billing)

A 68-year-old patient presents to a private ophthalmology practice reporting sudden, brief episodes of vision loss in the right eye (amaurosis fugax). The ophthalmologist performs ophthalmodynamometry of the right eye to assess retinal arterial perfusion pressure and documents significant asymmetry compared to the left eye, noting suspicion for right internal carotid artery stenosis. A formal written note and interpretation are dictated.

Bill:

• 92260-RT (unilateral, right eye, global)
• G45.3 (Amaurosis fugax — primary indication)
• I65.21 (Occlusion and stenosis of right carotid artery — if confirmed or suspected)

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Example 2 - Bilateral ODM with Modifier 50 (Private Practice)

Same patient scenario, but the ophthalmologist examines both eyes bilaterally to compare retinal arterial pressure measurements. Bilateral comparison is documented clearly in the chart.

Bill:

• 92260-50 (bilateral; bill at 150% of allowable)
• G45.3 (Amaurosis fugax)
• I65.23 (Occlusion and stenosis of bilateral carotid arteries — if documented)

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Example 3 - Split TC/PC Billing in HOPD Setting

ODM is performed in a hospital outpatient ophthalmology clinic using hospital-owned equipment. The ophthalmologist performs the procedure and dictates the interpretation; the hospital provides the room, equipment, and support staff.

Physician Bills:

• 92260-26 (professional component — interpretation and report)

Facility Bills:

• 92260-TC (technical component — equipment and staff)

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Example 4 - ODM Same Day as Comprehensive Ophthalmological Exam

A 72-year-old established patient with known low-tension glaucoma is seen for a comprehensive ophthalmological exam. During the same visit, the ophthalmologist additionally performs ODM to assess whether reduced optic nerve perfusion pressure is contributing to the patient’s ongoing glaucomatous progression. Both services are clearly documented with distinct medical necessity.

Bill:

• 92014 (Comprehensive ophthalmological exam, established patient)
• 92260-59 (ODM — distinct from the comprehensive exam; modifier 59 to indicate separate service)
• H40.1120 (Primary open-angle glaucoma, left eye, stage unspecified)
• I10 (Essential hypertension — documented contributing systemic factor)

📝 Audit Tip: When billing 92260 alongside an ophthalmological exam code on the same date, documentation must clearly reflect a separate and distinct clinical question driving the ODM. Payers may bundle the ODM into the exam code without strong documentation of separate medical necessity. The 59 modifier alone will not protect a claim that lacks supporting chart documentation.

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Example 5 - ABN / Non-Covered Scenario

An established patient with stable moderate glaucoma requests ophthalmodynamometry at their routine follow-up, but the clinical documentation does not support a specific vascular indication beyond general monitoring. The payer’s LCD does not cover ODM for this indication.

Action: Issue and obtain a signed ABN (Advance Beneficiary Notice) prior to the service.

Bill:

• 92260-GA (ABN on file; claim submitted to Medicare for potential denial; patient liability on file)
• H40.1110 (Primary open-angle glaucoma, right eye, stage unspecified)

Alternatively, if waiving Medicare entirely:

• 92260-GY (service is non-covered; patient billed directly)

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📎 Documentation Requirements

For 92260 to withstand audit scrutiny, the medical record should include all of the following:

1. Clinical indication — clearly stated reason why ODM is being performed (e.g., evaluate retinal arterial perfusion pressure asymmetry in context of suspected carotid stenosis; assess optic nerve perfusion pressure in low-tension glaucoma)
2. Technique — documented that an ophthalmodynamometer was applied to the eye with simultaneous fundoscopic observation
3. Measurements recorded — diastolic and systolic ODM readings for each eye tested, in mmHg
4. Bilateral comparison — if bilateral, document measurements for both eyes and clinical significance of asymmetry (if present)
5. Interpretation — physician’s formal interpretation of the ODM findings and correlation with clinical picture
6. Plan — how ODM findings inform the management plan (e.g., “ODM reveals >20% pressure asymmetry right vs. left; carotid duplex ordered”)
7. Physician signature and date — required for all diagnostic interpretations

⚠️ Documentation Pitfall: Simply noting “ODM performed bilaterally — normal” is insufficient. The actual numerical measurements must be recorded, and the interpretation must be linked to the clinical question. Vague or templated documentation is a common audit failure point for low-complexity diagnostic eye codes like 92260.

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🔁 Payer Considerations

• Medicare: Coverage is determined under the applicable MAC’s Local Coverage Determination (LCD) for Special Ophthalmological Services. Coverage is limited to medically indicated diagnoses — vascular evaluation, not routine screening. Verify the applicable LCD in your MAC jurisdiction (e.g., Novitas, CGS, WPS, First Coast, Noridian)
• Medicaid: Coverage varies significantly by state; some Medicaid programs (e.g., Rhode Island) explicitly include 92260 in their optometric/ophthalmologic procedure schedules
• Private Payers: Most commercial payers cover 92260 when medically indicated with a supported diagnosis, but reimbursement is low given the 0.50 wRVU base; verify individual payer fee schedules
• Frequency Limits (MUE): CMS Medically Unlikely Edit (MUE) for 92260 is typically 1 unit per day per beneficiary — confirm current MUE values via the CMS MUE table
• NCCI Edits: Review National Correct Coding Initiative (NCCI) bundling edits when billing 92260 alongside other ophthalmic diagnostic codes on the same date; some pairings may require a -59 modifier to bypass a column II edit

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^{Sources: AAPC Codify 92260 · AMA CPT 2025-2026 · MD Clarity CPT 92260 · GenHealth.ai 92260 · NIH VSAC Code System 92260 · CMS 2026 MPFS Final Rule MM14315 · ASCRS 2026 MPFS Final Rule Summary · Federal Register 1996 Vol.61 No.227 · Rhode Island Medicaid Optometric Code Schedule · CMS NCCI Policy Manual 2026 · Ophthalmology Advisor ICD-10 Codes}