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See a sample rate comparisonCPT 92274 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.
Retina Eye (Light) Test, Test To Measure Responsiveness Of Retina (Layer Of Tissue In The Eye That Sends Sight Messages To The Brain) To Light And Other External Stimuli. Used To Detect Damage To The Retina.
| 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 | 26 - Professional component PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $92.19 national non-facility rate (2026) · View Medicare rates for 92274 |
| Medicaid Fee Schedule | $74.775 median of the 8 states in the free preview · View Medicaid rates for 92274 |
National average reimbursement for CPT 92274 by major payers:
$120.38
$110.12
$107.20
$148.72
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CPT 92274
5 of 25 sample ratesHigher to lower in this preview
John Millichap
Pediatric Faculty Foundation In
$174.47Published rateDavid Lott
Edward Health Ventures
$136.36Published rateJeffrey Tsai
Town Center Orthopaedic Associates, P.C.
$76.78Published rateAsmat Jafry
Edward Health Ventures
$51.16Published rateAbbas Naqvi
Town Center Orthopaedic Associates, P.C.
$26.96Published rate
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See a sample payer proposalCPT 92274 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92274 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 92274 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 |
|---|---|---|
| 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 |
| 92270-CPT | Low | Retina Eye (Light) Test, Test To Measure Responsiveness Of Retina (Layer Of Tissue In The Eye That Sends Sight Messages To The Brain) To Light And Other External Stimuli. Used To Detect Damage To The Retina. |
| 92273-CPT | Low | Retina Eye (Light) Test, Test To Measure Responsiveness Of Retina (Layer Of Tissue In The Eye That Sends Sight Messages To The Brain) To Light And Other External Stimuli. Used To Detect Damage To The Retina. |
| 92274-CPT | Low | Retina Eye (Light) Test, Test To Measure Responsiveness Of Retina (Layer Of Tissue In The Eye That Sends Sight Messages To The Brain) To Light And Other External Stimuli. Used To Detect Damage To The Retina. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92274. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92274 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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