Basics of CPT code 99173, 99174 & 99177

Visual acuity refers to the clarity or clearness of the vision, a measure of how well a person sees. Visual acuity testing is used to determine how well a person can see at various distances using a Snellen chart. The Snellen chart is the familiar eye test with block letters that decrease in size corresponding to the distance at which the line of letters is normally visible. CPT code 99173, 99174, and 99177 are used for vision screening.

Visual acuity testing is normally performed as part of a pediatric preventive (well-child) visit. When acuity is measured as part of a general ophthalmological service or an evaluation/management service of the eye, it is a diagnostic examination and not a screening test, and should be reported using the appropriate ophthalmological service code (92002, 92004, 92012, 92014, 92081, 92082, or 92083) or evaluation and management codes (99201 to 99215).

The physician asks the patient to stand at a specified distance (20 feet for Snellen eye chart) from the chart. The patient is instructed to cover the left eye with the left hand or hold a card in front of the lens for those patients wearing eyeglasses. The patient reads the letters on the screen to test the visual acuity of the right eye. The process is repeated for the other eye. This exam identifies possible vision problems; it does not replace the examination by an ophthalmologist or optometrist and is used as a screening test only.

The screening test used must employ graduated visual acuity stimuli that allow a quantitative estimate of visual acuity [eg, Snellen chart]. Other identifiable services unrelated to this screening test provided at the same time may be reported separately [eg, preventive medicine services]. When acuity is measured as part of a general ophthalmological service or of an E/M service of the eye, it is a diagnostic examination and not a screening test.

Description of CPT code 99173, 99174, and 99177

99173 Screening test of visual acuity, quantitative, bilateral

99174 Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with remote analysis and report

99177  with on-site analysis

Medicaid payers are required to follow CMS NCCI rules for bundled services. Visual screening codes are bundled with Preventive Medicine codes and reimbursed as follows:

• CPT code 99172: Visual function screening is included in the Preventive Medicine Services and is not reimbursed separately.
• CPT code 99173: Visual acuity screening is reimbursed separately for members younger than 21.
• CPT codes 99174 and 99177: Instrument-based ocular screening including report using photoscreening is proven and medically necessary for vision screening for one of the following:

o As a mass screening instrument for children ages 1-3 (ends on 4th birthday).

o Children ages 4 and older who are developmentally delayed and are unable or unwilling to cooperate with routine visual acuity screening.

o Instrument-based ocular screening using photoscreening is unproven and not medically necessary for all other patient populations including children younger than 1. More age appropriate screening methods are available for these populations.

Payment policy for BCBS for CPT code 99173, 99174 & 99177

Visual acuity testing (CPT code 99173) is a covered, separately reimbursable service when performed in conjunction with a preventive medicine service code (99382, 99383, 99392, 99393) for patients aged 3-5 years. For all other ages, visual acuity screening is considered integral to an evaluation and management service or a preventive medicine examination and is not separately reimbursed. Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral (99174 and 99177) are covered and a separately reimbursable service.

The services are covered for twice per year for children ages 0-12 months and once per year for children 1-5. Instrument-based ocular screening (99174 and 99177) cannot be filed on the same day as visual acuity testing (CPT code 99173). For services rendered on children greater than age 5, the codes are covered but not separately reimbursed.

The following codes are covered and separately reimbursed for ages 0-5 and not separately reimbursed for ages greater that 5:

99173 Screening Test of Visual Acuity, Quantitative, Bilateral

99174 Instrument-based ocular screening (e.g.,, photoscreening, automated-refraction), bilateral; with remote analysis and report

99177 Instrument-based ocular screening (e.g.,, photoscreening, automated-refraction), bilateral; with onsite analysis

Do and Don’t with CPT code 99173, 99174 & 99177

Do not report CPT code 99173 in conjunction with CPT code  99172, 99174, 99177

Do not report CPT code 99174 in conjunction with CPT code 92002-92014, 99172, 99173, 99177

Do not report CPT code 99177 in conjunction with CPT code 92002-92014, 99172, 99173, 99174

NCCI edits with CPT code 99173, 99174 & 99177