CPT Code 92060 – Sensorimotor Examination: An Essential Code to the Pediatric Ophthalmology Practice

By Aaron Miller, MD, MBA (bio)

When deciding on pediatric ophthalmology as a subspecialty, one of the negative aspects reported was the lower earning potential of an individual within this field. Typically, examining children can take longer which results in fewer patient encounters in a given day. As such, maintaining a low overhead is essential to growing an efficient and profitable practice.

Any practice that focuses on providing eye care to children can be expected to have a larger presence of strabismus and amblyopia cases. It is in these patients that utilization of the sensorimotor examination code can prove to be an additional revenue source. The components of this examination are commonly performed in most pediatric eye visits but, in my experience, this code is not frequently coded and submitted for reimbursement.

By definition, a sensorimotor examination consists of multiple measurements of ocular deviations with interpretation and report. It includes measurement of ocular alignment in more than one field of gaze at distance and/or near (primary, up, down, left and right gaze) and inclusion of at least one appropriate sensory test in patients who are able to respond (Randot or Titmus test). This is considered a separately identifiable procedure that for billing purposes is in the realm of diagnostic testing procedures. The rules of billing for this test commonly mirror those for other diagnostic tests, such as a visual field test. If an individual is brought in to only have a sensorimotor examination without billing for an Eye or E/M code, no copayment is typically collected.

However, in most pediatric practices, a sensorimotor examination is rarely performed without an accompanying ocular examination. As such, concurrent coding for an Eye or E/M code with a sensorimotor code is appropriate and reimbursement for both should be expected. Payers vary in their rules so there can be situations where the sensorimotor examination is bundled within the regular eye examination. For example, Medicaid in Texas does not pay for both codes if performed on the same day. It is encouraged that contracts with payers be reviewed to determine individual reimbursement standards.

In summary, proper coding for sensorimotor examinations can increase visit revenue by 25-50% per patient. For a pediatric practice that typically has the challenges of fewer patient visits, this income can be invaluable in countering overhead expenses.