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See a sample rate comparisonCPT 92012 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 Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established 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 24 - Unrelated E/M service during postoperative period |
| Complexity Level | Low |
| Medicare Fee Schedule | $90.52 national non-facility rate (2026) · View Medicare rates for 92012 |
| Medicaid Fee Schedule | $71.79 median of the 8 states in the free preview · View Medicaid rates for 92012 |
National average reimbursement for CPT 92012 by major payers:
$84.31
$100.15
$104.82
$83.84
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CPT 92012
5 of 25 sample ratesHigher to lower in this preview
Jane Edmond
Dell Childrens Medical Group
$211.66Published rateAllan Robbins
Allan M. Robbins, M.D.
$108.55Published rateJason Wanner
Chesapeake Eye Care & Laser Center, P.C.
$88.62Published rateElaine Thung
Eye Physicians Of North Houston PA
$68.08Published rateFiaz Zaman
Bella Vista Eyecare Associates PA / Brookwood Eyecare Inc / Scrc Group Ltd LLP
$37.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 92012 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92012 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 92012 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 92012. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92012 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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