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See a sample rate comparisonCPT 92004 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.
Ophthalmological Services Med, Ophthalmological Services Medical Examination Andevaluation With Initiation Of Diagnostic And Treatment Program Comprehensive New Patient One Or More Visits
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 57 - Decision for surgery |
| Complexity Level | Low |
| Medicare Fee Schedule | $149.64 national non-facility rate (2026) · View Medicare rates for 92004 |
| Medicaid Fee Schedule | $118.75 median of the 8 states in the free preview · View Medicaid rates for 92004 |
National average reimbursement for CPT 92004 by major payers:
$136.57
$174.07
$179.83
$205.47
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CPT 92004
5 of 25 sample ratesHigher to lower in this preview
Lauren Hennein
Rady Childrens Hospital-San Diego
$395.92Published rateSarah Holy
Retina Consultants Of Houston, PLLC
$167.92Published rateBrandon Suedekum Md, PC
Brandon Suedekum Md PC
$137.94Published rateBruce Jones
Ivan H. Garcia, Md, P.C. T/A Omni Eye Specialists
$106.47Published rateMark Breazzano
Ophthalmology Medical Service Group Inc
$61.00Published rate
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See a sample payer proposalCPT 92004 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92004 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 92004 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 92004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92004 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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