CPT 92083, in plain terms, covers Extended visual field exam of 1 or both eyes, such as Goldmann with at least 3 isopters plus central static testing, or full automated threshold perimetry, with interpretation and report. CPT 92083 is referenced in 6 tracked payer policy changes from Aetna Better Health of Virginia, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92083 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 92083 on AAPC
Aetna Better Health of Virginia is correcting an error that caused claims to be wrongly denied when E&M services were billed together with specific ophthalmological procedure codes. The payer has removed these codes from the denial trigger list retroactively to July 1, 2025, and will automatically reprocess all affected claims after system updates are complete by February 1, 2026.
Aetna considers computerized visual field examination, gonioscopy, measurement of the optic nerve head and retinal nerve fiber layer, pachymetry and tonometry medically necessary for evaluation of primary open-angle glaucoma. Aetna considers the following experimental, investigational or unproven: artificial intelligence-based detection of glaucoma, continuous monitoring of intra-ocular pressure, genotyping and genetic testing for glaucoma, home-based perimetry, home tonometry such as the Icare Home Tonometer, measurement of corneal hysteresis, ocular blood flow analyzers and tonometers, provocative tests, rapid campimetry, the RETeval portable electroretinogram device, and visual evoked potential testing. The listed CPT codes are covered when selection criteria are met, and ICD-10 codes H40.1110 through H40.1194 for primary open-angle glaucoma are covered when selection criteria are met.
Aetna Clinical Policy Bulletin 1039 covers transverse venous sinus stent placement for medically refractory idiopathic intracranial hypertension. CPT 61635 and the listed stent HCPCS codes are covered when the policy's selection criteria are met, and intravascular ultrasound (CPT 37252 and 37253) is considered experimental, investigational or unproven for optimizing candidate selection.
Aetna considers computerized visual field examination, gonioscopy, measurement of the optic nerve head and retinal nerve fiber layer, pachymetry, and tonometry medically necessary for evaluation of primary open-angle glaucoma. Aetna considers artificial intelligence-based glaucoma detection, continuous intraocular pressure monitoring, glaucoma genetic testing, home-based perimetry, home tonometry such as the Icare Home Tonometer, corneal hysteresis measurement, ocular blood flow analyzers, provocative tests, rapid campimetry, the RETeval device, and visual evoked potentials experimental, investigational, or unproven. CPT codes 76514, 92020, 92081, 92082, 92083, 92100, 92133 and 92134 are covered if selection criteria are met, and CPT codes 0198T, 0329T, 0464T, 0509T, 92145, 92273, 92274, 99453, 99454 and 99457 are not covered for the indications listed.
Upper lid blepharoplasty is medically necessary to correct prosthesis difficulties in an anophthalmia socket, to relieve painful blepharospasm, to treat peri-orbital sequelae of thyroid disease and nerve palsy, or to remove excess upper eyelid tissue causing functional visual impairment when photographs and visual field testing from the past 12 months meet the stated criteria. Upper lid ptosis repair and brow ptosis repair for functional visual impairment are medically necessary when their listed criteria are met, and ectropion and entropion repair are medically necessary to repair defects predisposing to corneal or conjunctival injury when selection criteria are met. Surgical correction of congenital ptosis is medically necessary to allow proper visual development in infants and children when the ptosis interferes with the field of vision and the child has abnormal head posture, amblyopia or strabismus, and congenital ptosis surgery is considered cosmetic when performed for mild ptosis that is only of cosmetic concern.
Alaska Medicaid clarifies that vision exams are limited to one per calendar year, with additional exams for children requiring medical justification and adults requiring prior authorization. The policy specifies which CPT codes are subject to this limit and outlines required components for covered vision exams.
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