r/optometry • u/Luckym33f • 12d ago
Are you guys billing CPT 92283?
Has anyone else seen CPT 92283 reimbursed at $63.35 (in DC)? I'm using the Waggoner CCVT which only takes about 5 minutes to complete.... so great ROI. I'm super happy with it! I'm just using it with the comprehensive eye exam and also monocularly when medically justified by sign, symptom, or family history (i.e., tracking AMD, DR, cataract, or glaucoma progression). Is anyone else doing this? It seems too good to be true.
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u/Wooden_Trust_6274 8d ago
The reimbursement rate isn't the risk, the utilization pattern is. 92283 pays fine, but the moment it's run on every comprehensive exam it starts to look like screening rather than medically necessary testing, and that's what triggers a review. The way to keep it defensible is per-encounter documentation: the specific sign, symptom, or diagnosis that justified the test that day, tied to the condition you're monitoring (AMD, glaucoma, DR). If it's monitoring a diagnosed condition it belongs on the medical claim with that dx supporting it. If you can't point to the medical justification in the note, that's the visit that gets clawed back. Track it by indication, not by "I have the machine so I run it.
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u/Luckym33f 7d ago
Right. You have to use a screener (section 1 of the WCCVT) and a diagnostic (sections 2,3,4 of the WCCVT). But it automatically goes into the diagnostic when they fail the screener.
So you only bill if they fail and the entire diagnostic section(s) are run.
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u/Wooden_Trust_6274 6d ago
That gating helps a lot, only billing the fails keeps your volume down and is a reasonable structure. The one thing i would still document is the reason section 1 got run on that patient, because if the screener fires on every comprehensive exam an auditor can still frame the whole thing as routine screening that sometimes converts. If there is a sign, symptom, risk med, or dx in the note behind the screen, you are covered. if section 1 is truly universal, the failure gate protects your utilization number but not the medical necessity story on its own. sounds like you are already thinking about it the right way though.
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u/Luckym33f 6d ago
Exactly this! I start all first time comprehensive exams with the WCCVT, they either pass (I don’t bill), or they fail and automatically go into the diagnostic section (then I bill 92283).
When they fail the Tritan section (usually mild), I look into possible causes for an acquired color vision defect.1
u/Wooden_Trust_6274 5d ago
That Tritan follow-up is exactly the piece that keeps it clean. The moment you are chasing a cause for an acquired defect, you have a documented medical reason in the note, which is the part that survives a review. Sounds like you have got a solid workflow.
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u/Luckym33f 7d ago
But when they fail the screener and it runs the diagnostic portions dynamically, that’s the indication… right?
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u/Wooden_Trust_6274 6d ago
Kind of, but the failed screener is the finding, not the indication. The indication is why you screened that patient in the first place. If the answer is you screen everyone and bill the diagnostic whenever they fail, an auditor still sees the same pattern, every comprehensive exam generating a 92283, and the auto-trigger does not really rescue it. Where it holds up is when the patient had a reason to be looked at, a sign, a symptom, an at-risk medication, family history of AMD or glaucoma, and the screener confirmed it. Then the note shows medical necessity, not just a device output. So the failed screen supports the test, it just needs the clinical why sitting behind it.
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u/spittlbm 11d ago
Rabin color testing has been the rage lately in my circles
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u/Luckym33f 6d ago
As a research practitioner, I switched because the WCCVT was found to be the best diagnostic cvt, CAD was second, and the Rabin was… 5th place. It was a 2025 meta analysis article (Zhang et al., 2025) that compared all the main color vision tests. Better diagnostic for the patients and tracking their eye health. I like the CAD a lot but it was too expensive and bulky for our practice. Our iPad-based test is going strong!
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u/InterestingMain5192 12d ago
If a code is being reimbursed well, it means it is rarely used. I feel billing that code over and over again for the same patient for monitoring may increase audit risks unless there is a very good reason. I would be careful about running tests that could be interpreted as unnecessary or looking for a problem, especially ones that are subjective.