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  • Dilated Eye Form (pdf) - Tn.gov - State Tn

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State?of?Tennessee? TENNESSEE?ATHLETIC?COMMISSION? DEPARTMENT?OF?COMMERCE?AND?INSURANCE? 500 JAMES?ROBERTSON?PARKWAY? NASHVILLE, TENNESSEE? 37243? Professional?Athlete?Dilated?Eye?Exam? Only?a?licensed?Ophthalmologist?or?Optometrist?may?conduct?this?examination?and?complete?this?form.?.

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If an ophthalmologist or optometrist performs an annual dilated eye examination to diagnose, monitor or treat the patient for diabetic retinopathy, HMSA and HPH would prefer that the provider bill using ophthalmological service codes (CPT 92002-92014).

In fact, it could be considered below the standard of care to not do so. No, a provider cannot mandate a patient to do a pupil dilation but if needed would explain why to the patient. If the patient still refused dilation, the provider would likely document that the patient refused dilation.

HCPCS Code for Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy M1220.

As you can see, there is no CPT code for a dilated eye examination. Dilation is not billed separately, but rather is included in the choice of codes, 99000 or 92000 visits.

The Medicare allowable for 99204 is $185.26. The allowable for 92004 is $165.97. What code would you choose? Answer: Choose 99204, as it has almost a $20.00 higher allowable than 92004.

Second, even though coding 92004 and 92014 does not require dilation, doctors of optometry should still consider dilation essential unless medically contraindicated. Current clinical practice guidelines recommend dilation as a standard of care.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232