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See a sample rate comparisonCPT 92260 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.
Measure Pressure In Eye Artery, Test To Measure Pressure In The Central Artery Located In The Retina (Layer Of Tissue In The Eye That Sends Sight Messages To The Brain).
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 22 - Increased Procedural Services |
| Complexity Level | Low |
| Medicare Fee Schedule | $18.71 national non-facility rate (2026) · View Medicare rates for 92260 |
| Medicaid Fee Schedule | $15.16 median of the 8 states in the free preview · View Medicaid rates for 92260 |
National average reimbursement for CPT 92260 by major payers:
$23.46
$22.75
$22.01
$18.47
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CPT 92260
5 of 25 sample ratesHigher to lower in this preview
Srishti Nangia
$58.45Published rateAbby Fredrickson
$38.27Published rateDivakar Mithal
Pediatric Faculty Foundation In
$35.63Published rateJamie Evans
Loyola University Medical Center
$27.87Published rateMarcus Byrd
New York City Health And Hospitals Corporation
$15.13Published rate
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See a sample payer proposalCPT 92260 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92260 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 92260 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 |
|---|---|---|
| 92230-CPT | Low | X-Ray Of Eye Blood Vessels, Examination And X-Ray Of The Inside Of Blood Vessels In The Eye. Dye Makes The Area Of Interest Easier To See. The Procedure Is Used To Evaluate Problems With The Retina. |
| 92250-CPT | Low | Fundus Photography With Interp, Fundus Photography With Interpretation And Reportfundus Photography With Interpretation And Report |
| 92260-CPT | Low | Measure Pressure In Eye Artery, Test To Measure Pressure In The Central Artery Located In The Retina (Layer Of Tissue In The Eye That Sends Sight Messages To The Brain). |
| 92265-CPT | Low | Needle Oculoelectromyography, Needle Oculoelectromyography One Or More Extraocularmuscles One Or Both Eyes With Interpretation And Report Needle Oculoelectromyography One Or More Extraocular |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92260 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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