Generating S-Codes

Beginning January 2026, providers in Arkansas are required to report routine eye exams using S-codes rather than the standard CPT codes. Continue to use 920XX and 992XX for medical eyecare billing.

To bill S-codes rather than 920XX or 992XX, doctors must indicate that option within the Refraction plan. You can create protocols to partially automate this process.

What do you want to do?

S-codes are part of the HCPCS Level II coding system, created by commercial insurance payers to report services and supplies not covered under CPT codes. They are not recognized by Medicare or other federal programs.

Code Description
S0620 Routine eye exam including refraction, new patient
S0621 Routine eye exam including refraction, established patient
  1. Document the visit as you normally would.
  2. Within Impressions and Plans or the Ocular Exam, add or resume the Refraction plan.
  3. Click the S-codes tab.
  4. Click the Override E/M Visit Billing drop-down menu and select the appropriate S-code.

You can partially automate generating S-codes by creating protocols. How you handle this depends on how you like to document your visits.

Option 1: Create Generic Protocols (easy setup, more edits to visits)

Create a protocol for each common refractive diagnosis (e.g., myopia OU, hyperopia OU, astigmatism OU) that includes a refraction plan and the S-code for established patient.

During the visit, apply the appropriate protocol. You'll need to resume the refraction plan only if you need to change the laterality (e.g., OD, OS) or you need to change the S-code from established to new patient.

To illustrate, here's the protocol for myopia:

  • Myopia OU, established patient (S0621)

Option 2: Create Detailed Protocols (middle-of-the-road option)

Create two protocols (e.g., new, established) for each common refractive diagnosis (e.g., myopia OU, hyperopia OU, astigmatism OU). Each protocol should include a refraction plan with the S-code for new patients (S0620) or established patients (S0621).

During the visit, apply the appropriate protocol. You'll need to resume the refraction plan only if you need to change the laterality (e.g., OD, OS).

To illustrate, here are the protocols for myopia:

  • Myopia OU, new patient (S0620)
  • Myopia OU, established patient (S0621)

Option 3: Create Highly Specific Protocols (more setup, fewer edits to visits)

Create several highly specific protocols. Each protocol would be specific to a refractive diagnosis (e.g., myopia, hyperopia, astigmatism), a laterality (e.g., OD, OS, OU) , and the type of patient (e.g., new, established).

During the visit, select the specific protocol.

To illustrate, here are the protocols for myopia:

  • Myopia OU, new patient (S0620)
  • Myopia OD, new patient (S0620)
  • Myopia OS, new patient (S0620)
  • Myopia OU, established patient (S0621)
  • Myopia OD, established patient (S0621)
  • Myopia OS, established patient (S0621)

To illustrate, here are the protocols for myopia:

  • Myopia OU, new patient (S0620)
  • Myopia OU, established patient (S0621)

Option 3: Create Highly Specific Protocols

Create several highly specific protocols. Each protocol would be specific to a refractive diagnosis (e.g., myopia, hyperopia, astigmatism), a laterality (e.g., OD, OS, OU) , and the type of patient (e.g., new, established). During the visit, select the specific protocol.

To illustrate, here are the protocols for myopia:

  • Myopia OU, new patient (S0620)
  • Myopia OD, new patient (S0620)
  • Myopia OS, new patient (S0620)
  • Myopia OU, established patient (S0621)
  • Myopia OD, established patient (S0621)
  • Myopia OS, established patient (S0621)