As an eye care provider, you play a crucial role in the early detection and timely treatment of diabetes‑related eye diseases such as diabetic retinopathy. More than one in three adults with diabetes has signs of diabetic retinopathy, underscoring the importance of routine retinal evaluation for this population.* To ensure patients with evidence of retinopathy receive an annual eye exam, NCQA® developed the Eye Exam for Patients with Diabetes (EED) measure within the Healthcare Effectiveness Data and Information Set (HEDIS®). This measure evaluates the percentage of patients aged 18–75 with a diagnosis of diabetes (type 1 or type 2) who received a retinal eye exam.
What is the HEDIS® measure specific to diabetics and eye exams?
This measure assesses the percentage of persons 18–75 years of age with diabetes (type 1 or type 2) who had a retinal eye exam.
How is the diabetic eye exam identified and monitored?
Screening or monitoring for diabetic retinal disease is identified by one of the following:
- A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement period (January 1, 2026 – December 31, 2026).
- A negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to the measurement period. (2025)
Procedural Notations
- If your patient has diabetes and does not have retinal disease, one of the CPTII codes below must be added to your claim, OR, one of the three ICD-10 codes listed below must be the Primary Diagnosis code for the claim.
It is a critical claim submission component that CPT**, CPTII and ICD-10 codes be added to the claim to demonstrate the outcome of retinal exams related to the HEDIS® measure.
| Code Type | Code | Definition | With/Without Retinopathy |
| CPT | 92229 | Autonomous eye examination | With/Without |
| CPT | 92002/92004/92012/92014 | Ophthalmological services | With/Without |
| CPT | 92018/92019 | Ophthalmological examination under general anesthesia | With/Without |
| CPT | 92134/92137 | Computerized ophthalmic diagnostic imaging | With/Without |
| CPT | 92201/92202 | Ophthalmoscopy with interpretation and report | With/Without |
| CPT | 92227/92228 | Imaging of retina for detection of disease | With/Without |
| CPT | 92235 | Ophthalmic angiography | With/Without |
| CPT | 92230/92250 | Ophthalmoscopy with medical diagnostic evaluation | With/Without |
| CPT | 99203/99204/99205 | New patient office visit requiring 30+ minutes | With/Without |
| CPT | 99213/99214/99215 | Established patient office visit | With/Without |
| CPT | 99242/99243/99244/99245 | Office consultation for a new or established patient | With/Without |
| CPTII | 2022F
2024F 2026F |
Dilated retinal eye exam
Seven standard field stereoscopic retinal photos Eye imaging validated to match diagnosis from seven standard field with evidence of retinopathy |
With |
| CPTII | 2023F
2025F 2033F |
Dilated retinal eye
Seven standard field stereoscopic retinal photos Eye imaging validated to match diagnosis from seven standard field without evidence of retinopathy |
Without |
| CPTII | 3072F | Low risk/negative for retinopathy in prior year (2025) | Without |
| ICD10 | E10.9, E11.9, E13.9 | Type 1/Type 2/Other specified diabetes mellitus without complications | Without |
How to Document
At a minimum, documentation in the medical record must include one of the following:
- A note or letter prepared by an ophthalmologist, optometrist, PCP, or other healthcare professional that an optometrist or ophthalmologist completed an ophthalmoscopic exam, the date when the procedure was performed, and the results of the procedure
- A chart or photograph indicating the date when the fundus photography was performed and one of the following:
- evidence that an optometrist/ophthalmologist reviewed the results
- evidence results were read by a system that provides an artificial intelligence (AI) interpretation
- evidence that the patient had bilateral eye enucleation of acquired absence of both eyes; look as far back as possible in the patient’s history through December 31, 2025
Documentation of a negative retinal or dilated eye exam by an optometrist/ophthalmologist in 2025, where results indicate that retinopathy was not present
*Centers for Disease Control and Prevention. Promoting Eye Health.
**CPT codes, descriptions, and two-digit numeric modifiers only are copyright of the 2026 American Medical Association. All rights reserved.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Measure specifications are from NCQA.