Regular retinal eye exams are one of the most effective ways to detect diabetic retinopathy early and help prevent vision loss. For members with diabetes, primary care providers, endocrinologists, and internal medicine providers play an important role in encouraging annual eye exams, coordinating referrals, and documenting results with the appropriate CPT II codes.
Why it matters
Diabetic retinopathy is a common complication of diabetes and can progress without noticeable symptoms. Retinal eye exams support early detection, timely intervention, and better patient outcomes. They also help close gaps for the Eye Exam for Patients With Diabetes measure, which focuses on members ages 18–75 with type 1 or type 2 diabetes who receive appropriate retinal screening or monitoring.
Best practices for meeting the diabetic eye exam measure
- Education and outreach: Educate patients about the risk of diabetic eye diseases and encourage routine retinal eye exams, especially for those who have not had a recent exam.
- Vision referrals: Refer patients to an optometrist or ophthalmologist for a diabetic retinal eye exam when they are due.
- EMR alerts: Use electronic medical record (EMR) alerts to flag patients who need an eye exam.
- Fax-back forms: Use fax-back forms to collect results from an optometrist or ophthalmologist and return to Quality Improvement via fax at 801-442-0920. See the form for further instructions.
- Vision provider reviews: If your office performs retinal imaging (e.g., RetinaVue), ensure images are read by an optometrist or ophthalmologist. AI interpretation counts for one year only.
What to document when a report is not available
If an eye exam report is not available, document the exam details in the medical record. Include the exam date, eye care provider’s name and type, and the results. For example: “Last retinal eye exam with John Smith, OD, was June 2026 — no retinopathy.”
Why CPT II codes are important
Including CPT II result codes on claims helps Select Health identify and close care gaps more accurately and quickly. These codes also reduce the need for medical record abstraction, support more accurate quality data, and help improve patient outcomes.
CPT II codes for primary care providers
NOTE: All options must be interpreted by an ophthalmologist or optometrist
Codes for PCPs
- 92227 or 92228: Use when retinal imaging is performed in your office. These codes count for one year only.
- CPT II result codes: Use codes such as 2023F, 2025F, 2033F, 2022F, 2024F, or 2026F when documenting results from an eye specialist’s examination. These may count for up to two years, depending on the findings.
Codes for vision providers only
- 92250: This code only counts when billed by an ophthalmologist or optometrist.