CPT 92012 Medicare Fee Schedule 2026
Medicare's 2026 national payment for CPT 92012 is $90.52 in a non-facility setting ($41.42 in a facility), up 6.0% from $85.40 in 2025.
- Non-facility
- $90.52
- Facility
- $41.42
- vs. 2025
- +6.0%
- Commercial national avg.
- $93.28
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Run a free sample reportIntrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient
| Code | Date | State | Locality | Carrier | Non-Facility Fee | Facility Fee | Description |
|---|---|---|---|---|---|---|---|
| 92012 | 10/2026 | N/A | 00 | 00000 | $90.52 | $41.42 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92012 | 7/2026 | N/A | 00 | 00000 | $90.52 | $41.42 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92012 | 4/2026 | N/A | 00 | 00000 | $90.52 | $41.42 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92012 | 1/2026 | N/A | 00 | 00000 | $90.52 | $41.42 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92012 | 10/2025 | N/A | 00 | 00000 | $85.40 | $47.87 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92012 | 7/2025 | N/A | 00 | 00000 | $85.40 | $47.87 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92012 | 4/2025 | N/A | 00 | 00000 | $85.40 | $47.87 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92012 | 1/2025 | N/A | 00 | 00000 | $85.40 | $47.87 | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
92012 national rate by year
Each row is the latest CMS file published that year. Change is against the year before.
| CMS file | Non-facility | Facility | Change |
|---|---|---|---|
| October 2026 | $90.52 | $41.42 | +6.0% |
| October 2025 | $85.40 | $47.87 | -3.9% |
| March 2024 | $88.88 | $49.27 | -1.8% |
| January 2023 | $90.48 | $50.49 | -0.2% |
| July 2022 | $90.67 | $51.22 | - |
This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.
92012: Medicare vs. commercial national average
The commercial national average for 92012, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $93.28, 103% of Medicare's $90.52.
- BCBS $84.31
- UnitedHealthcare $100.15
- Aetna $104.82
- Cigna $83.84
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 92012 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.
Nearby codes
Compare Medicare's rate for 92012 with published commercial rates
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See what state Medicaid programs pay for 92012
50 state Medicaid agencies publish their own physician fee schedule. The 92012 page shows real published rates for several of them free, with effective dates and official sources.
17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.
Related codes
Methodology
Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.
View CMS Physician Fee Schedule