What You’ll Learn:

Understanding the Codes:

  • CPT 920X4 — Comprehensive eye exam for new (04) or established (14) patients.

  • CPT 92137 — Advanced retinal imaging, including OCT angiography (OCTA).

When You Can Bill Together:

  • How to establish medical necessity for OCTA as a distinct service.

  • The role of separate documentation and interpretation/report requirements.

Avoiding Denials & Bundling Pitfalls:

  • Why insurers may bundle 920X4 and 92137 into a single service.

  • Differentiating routine vs. medical exams and the importance of linking OCTA to exam findings.

Practical Documentation Strategies:

  • Recording exam findings that trigger the test.

  • Writing a compliant order for OCTA.

  • Using Modifier 25 appropriately to support separate billing.

Key Compliance Takeaway:

  • The CCI edit does not apply to Evaluation & Management (E/M) codes 99202–99205 and 99212–99215.

Who Should Take This Course:


  • Optometrists and ophthalmologists who perform OCTA.

  • Billing and coding staff responsible for ophthalmic claims.

  • Office managers who oversee compliance.


By the end of this mini-course, you’ll know exactly when and how to bill CPT 920X4 and 92137 together, how to document appropriately, and how to prevent costly denials—keeping your practice compliant, protected, and profitable.

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Course Guide

Founder John Rumpakis, OD, MBA

Dr. Rumpakis has developed some of the leading Internet-based software applications for the medical/eye care field such as CodeSAFEPLUS.com® (www.CodeSAFEPLUS.com), the industry leading cloud-based CPT & ICD Code Data and Information Service, and offers personal medical coding consultation through JustAskJohn (www.JustAskJohn.net). He is also the founder of Opt-ED® Professional Continuing Education (www.Opt-ED.com) which creates and delivers top tier continuing education around the country as well as Opt-IN® which provides optometric consulting, strategic and tactical services. Dr. Rumpakis was the Chief Medical Coding Editor for Review of Optometry & Optometric Management for nearly two decades and he has been extensively published on the topics of third party coding, billing & compliance, strategy development and execution, practice management, team building, maximizing effectiveness and profitability, including the textbook “Business Aspects of Optometry”. Dr. Rumpakis is a popular lecturer both nationally and internationally. He is a regular contributor to Review of Cornea and Contact Lens, Optometry Times, and Primary Care Optometry News. In addition to having had a successful solo practice, Dr. Rumpakis developed the practice management curriculum at Pacific University College of Optometry and taught optometric & medical economics there for over a decade and was recently named the University of Houston College of Optometry’s Benedict Professor for 2016-2017. A 1984 graduate of Pacific University College of Optometry, he served as a volunteer for the AOA for near 17 years and sits on numerous advisory boards, and board of directors for companies both in and out of the ophthalmic industry. Dr. Rumpakis also offers speaking and lecture services globally. A nationally recognized expert in medical coding, medical record compliance, practice economics and leadership & team-building, he provides nearly 750 hours per year in CE lectures.