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See a sample rate comparisonCPT 92002 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Intrm Oph Exam New Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Of Diagnostic And Treatment Program Intermediate New Patient
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $84.84 national non-facility rate (2026) · View Medicare rates for 92002 |
| Medicaid Fee Schedule | $67.46 median of the 8 states in the free preview · View Medicaid rates for 92002 |
National average reimbursement for CPT 92002 by major payers:
$81.44
$95.95
$100.42
$78.52
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CPT 92002
5 of 25 sample ratesHigher to lower in this preview
Peacehealth, St. John Medical Center
$886.90Published rateAlle-Kiski Medical Center, Allegheny Valley Hospital
Highmark Health
$371.42Published rateParish Hospital Service District For The Parish Of Orleans, New Orleans East Hospital
$171.47Published rateOklahoma Pet Center LLC
$76.40Published rateMiguel Arenas
Miguel A Arenas Md PC
$38.86Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 92002 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92002 code is part of the Medicine Services and Procedures services used for Ophthalmology Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 92002 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 92002-CPT | Low | Intrm Oph Exam New Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Of Diagnostic And Treatment Program Intermediate New Patient |
| 92004-CPT | Low | Ophthalmological Services Med, Ophthalmological Services Medical Examination Andevaluation With Initiation Of Diagnostic And Treatment Program Comprehensive New Patient One Or More Visits |
| 92012-CPT | Low | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92014-CPT | Low | Compre Oph Exam Est Pt 1, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Comprehensive Established Patient 1 Or More Visits |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92002. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92002 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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