The Medical Physician Fee Schedule (MPFS) took a payment cut in 2025. Average reimbursement dropped by 2.93% compared to 2024, and even these small reimbursement changes can have a major impact on eye care practices. This reduction means that practices conducting visual field tests (which Medicare does cover when medically necessary) now face tighter margins. Medicare scrutiny and utilization review are also increasing, so in order to avoid denials, your tests must be well-documented.

Rates rise and fall, and if your practice isn’t prepared, reimbursement and coverage policy can erode your profit margin. Review the nuances of visual field documentation requirements, Medicare submission, and how technology can help you stay compliant and properly reimbursed in 2025.

Visual Field CPT Codes for Medicare Claims

First, understand the CPT codes used for visual field testing. Make sure you’re using the correct codes, since 92081, 92082, and 92083 all had description changes in 2024.

• 92081: Visual field exam, unilateral or bilateral, with interpretation and report. This is a limited exam that would normally be conducted during a comprehensive screening. 

• 92082: Visual field exam, unilateral or bilateral, with interpretation and report. This exam is more advanced than 92081 and is considered intermediate. This includes at least two isopters on kinetic perimetry and automated suprathreshold screening. 

• 92083: Visual field exam, unilateral or bilateral, with interpretation and report. This is the extended examination with at least three isopters plotted and full threshold testing (like exams 24-2 or 30-2). 

Medicare assumes the test is done on both eyes. When performed bilaterally, visual field testing is billed as a single unit without modifiers. Use modifiers for laterality (-RT or -LT) only when the test is conducted on one eye.

Other modifiers, like -26 and -TC, refer to the professional and technical components. Modifier -26 (professional component) is used to indicate that a healthcare professional only provided the interpretation and report, while the technical component (modifier -TC, technical component) was provided separately.

The 2.93% reduction does apply to the Medicare visual field testing 2025 rates. The relative value units (RVUs) have a small estimated 0.02% adjustment.

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Key Medicare Visual Field Testing 2025 Updates You Should Know

This year’s MPFS cut comes after the expiration of a temporary increase in 2024 and a freeze on overall payment updates. These rates change often, and there could be increases next year.

With the updated Medicare Physician Fee Schedule 2025, eye care practices should pay close attention to changes in revenue. The 2.93% conversion-factor decrease and its dollar impact might not seem like much, but that takes the conversion factor (dollars per RVU) for CPT 92083 reimbursement down from an average of $33.29 to $32.35. If you serve a patient population that requires frequent glaucoma screenings, that $0.94 loss per visit can add up quickly. If you conduct 100 of these exams per month, that’s $1,128 in lost revenue over the year.

Bundling changes and status-indicator shifts that affect same-day services also warrant your attention. CMS often revises service bundling rules to promote care coordination and reduce duplicative billing. For 2025, changes include adjustments in status indicators that impact which visual field tests can be billed together on the same day without being denied.

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Medicare Coverage Criteria and Frequency Limits

Medicare covers visual field testing primarily for medical eye conditions. Approved ICD-10 diagnoses include glaucoma, neurologic visual defects, injuries, and some eyelid disorders that affect visual function.

For stable glaucoma, Medicare typically allows one visual field test per year. High-risk and progressing cases are allowed more frequent testing (usually every 6 to 12 months). If a patient is progressing very quickly, Medicare may allow up to three tests per year, but will require clinical justification. Regularly review updated Local Coverage Determinations (LCDs) because some regions will have specific frequency limits.

Documentation and Medical-Necessity Essentials

The best way to avoid Medicare denials for 92083, 92082, and 92081 is through clear documentation and note-taking.

Compliance requires these chart elements:

1. Reason for the test. When considering medical necessity, visual field documentation is a must. Include a clear reason to test based on the patient’s signs, symptoms, or diagnosis.
2. Reliability indices. Not all visual field tests are created equal. Test validity matters, and if you’re using Virtual Field, these reliability indices are automatic.
3. Interpretation. Include the physician’s interpretation of the visual field results, including a report summarizing findings.
4. Treatment plan. Document the decision-making prompted by the test results and show how the test influenced patient care.

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Because approvals and audit defense hinge on this documentation, you must always use timestamped, unaltered test records. Maintaining optometry compliance with Medicare involves storing test data in standard, interoperable formats — usually DICOM (digital imaging and communications in medicine). This maintains authenticity and traceability. Incorporate these best practices and monitor your practice management analytics to avoid unnecessary denials.

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Common Denial Triggers and How to Avoid Them

Even when the documentation is in place, denials are still possible. Thankfully, most of the common denial triggers are simple to avoid if you’re paying attention.

• Mismatched laterality. Visual field CPT codes are assumed bilateral unless indicated otherwise, so you shouldn’t submit two separate lines with LT and RT modifiers. Check that the laterality refers to the patient, not the observer’s perspective.

• Unsupported repeat testing. Medicare limits frequency, and without proper clinical documentation justifying medical necessity, repeat exams will be denied. Document disease progression or new symptoms if patients require more frequent tests.

• Improper modifier usage. Incorrect use or omission of modifiers that indicate unrelated procedures or post-operative care can trigger denials. Train staff and use auditing tools to verify modifiers before claims submission.

• Untimely filing. Medicare enforces filing deadlines (usually 90 days), and late submission results in automatic denials. Automated workflows and calendar reminders help keep submissions on schedule.

• Missing physician signature on interpretation. The very last step is also one of the easiest to forget. Always check for a valid physician's signature before submitting claims.

Billing Scenarios You Might Encounter

Bilateral visual field exams apply to the majority of patients, but some will only need one eye examined — for example, a patient with visual pathway damage in the left eye due to stroke. Addressing complex unilateral vision loss and monitoring progression would likely require a more detailed exam, so this would be billed as 92083-LT.

Modifier -25 is used to indicate that a significant, separately identifiable evaluation and management (E/M) service was performed on the same day as the visual field test. This modifier allows you to bill both the visual field test and an office visit on the same day without bundling payments.

Modifier -59 signals that a procedure or a service is distinct from other services. For example, if a patient has a 24-2 visual field test using CPT code 92083 for glaucoma screening, and they also need a Goldmann visual field test for neurological assessment, you can bill CPT code 92082-59 for the same visit, since they’re separate procedures with a different clinical indication. 

Best Practice Workflows

Clean claim submission and real-time eligibility checks will help keep your workflows smooth. Begin by verifying the patient’s Medicare eligibility and coverage at the time of service. Ensure CPT codes align with the documented complexity and laterality, and make sure modifiers are applied. Check for the necessary medical documentation, include details in the patient records, and submit claims promptly. Don’t forget to collect the physician’s signature on the interpretation.

Leveraging Technology to Stay Compliant

Even with the best intentions, claims denials are still a risk, but Virtual Field’s FDA-registered virtual reality visual field device helps you get a step ahead. Our technology auto-captures reliability indices, stores tests securely in the cloud, and exports files for your EHR to help you reduce audit risk. Virtual Field testing is billable, just like traditional tabletop perimetry. Using a portable, patient-friendly headset gives you an opportunity to test in more settings, support more patients, and offer more comprehensive exams while maintaining reliability.

Ready to see how it could look in your practice? Request a demo of Virtual Field today.

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