How much does Medicare pay for CPT 92002?

Medicare allowed an average of $84.57 per service and paid $58.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $163.36, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92002?

New patient problem focused exam of visual system. It was billed 78,491 times to 78,480 Medicare beneficiaries by 2,365 providers in 2024.

Does 92002 pay differently in an office than a hospital?

Yes. The allowed amount averaged $85.63 in an office setting and $46.41 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 92002 most?

Optometry, with 40,026 services from 1,037 clinicians. Next are Ophthalmology, Plastic and Reconstructive Surgery, Physician Assistant.

CPT 92002

New patient problem focused exam of visual system

$84.57Medicare-allowed amount per service, averaged across 78,491 services

Providers submitted

$163.36

Asking price, not received

Medicare allowed

$84.57

The fee schedule figure

Medicare paid

$58.27

Balance is patient coinsurance

Providers submitted an average of $163.36 for this code and Medicare allowed $84.57 — 1.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $58.27 (69%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $85.63
Hospital / facility: $46.41

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 76,384 services were billed in an office setting and 2,107 in a facility.

Services: 78,491
Beneficiaries: 78,480
Providers billing it: 2,365
Total allowed: $6,637,984

What Medicare pays for CPT 92002

Across 78,491 services billed by 2,365 providers to 78,480 beneficiaries, Medicare allowed an average of $84.57 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 92002

Specialty	Services	Beneficiaries	Avg allowed	Providers
Optometry	40,026	40,017	$84.80	1,037
Ophthalmology	38,169	38,167	$84.33	1,320
Plastic and Reconstructive Surgery	162	162	$95.41	1
Physician Assistant	56	56	$67.25	3
Nurse Practitioner	43	43	$65.04	2
General Practice	21	21	$107.78	1
Otolaryngology	14	14	$82.90	1

92002 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	15,224	$91.73	$59.82	293
California	8,254	$93.18	$56.90	248
Texas	7,770	$81.49	$54.84	256
Florida	6,042	$82.36	$55.23	183
New Jersey	4,079	$91.02	$58.07	125
Illinois	3,644	$77.50	$52.19	118
Pennsylvania	3,581	$80.70	$57.64	112
Maryland	2,574	$89.78	$59.80	52
Massachusetts	2,184	$83.46	$54.08	80
Connecticut	2,047	$87.35	$58.95	48
Virginia	1,868	$82.38	$57.22	50
Tennessee	1,422	$76.85	$55.23	63
Kansas	1,299	$78.62	$53.14	40
Georgia	1,100	$77.91	$52.38	36
Arizona	1,061	$81.54	$54.35	40
Louisiana	1,054	$76.13	$55.79	48
Arkansas	955	$73.93	$53.35	30
Mississippi	950	$75.06	$56.30	34
Missouri	838	$75.60	$52.39	37
Oklahoma	835	$77.37	$55.98	21
South Carolina	828	$79.27	$56.57	29
Iowa	744	$77.47	$51.84	33
North Carolina	738	$74.41	$53.09	29
Michigan	720	$79.58	$54.55	38
Delaware	695	$82.18	$65.30	3
Indiana	621	$74.81	$55.29	22
New Mexico	604	$78.35	$57.07	11
Washington	597	$84.71	$51.61	16
Kentucky	549	$72.11	$54.08	21
Rhode Island	485	$80.14	$61.85	5
Utah	464	$73.42	$48.90	20
Colorado	462	$73.24	$41.35	25
Ohio	420	$69.97	$47.67	24
Minnesota	416	$84.48	$52.70	20
Idaho	402	$78.57	$53.58	16
Oregon	320	$81.08	$48.77	16
Nebraska	296	$78.19	$49.88	11
South Dakota	282	$82.85	$53.69	12
West Virginia	265	$76.27	$54.39	11
New Hampshire	245	$82.98	$52.88	12
Alabama	204	$74.03	$55.82	12
Puerto Rico	197	$80.20	$54.30	6
Wisconsin	165	$77.76	$48.97	9
Nevada	161	$82.66	$50.00	6
North Dakota	154	$77.39	$42.08	7
Vermont	138	$78.18	$51.95	7
Hawaii	125	$87.30	$48.91	7
Alaska	115	$96.95	$48.12	6
Montana	85	$84.50	$53.32	5
Maine	57	$82.01	$52.59	4
District of Columbia	55	$88.19	$48.73	3
U.S. Virgin Islands	39	$83.17	$43.90	2
ZZ	23	$80.11	$53.96	1
Northern Mariana Islands	22	$91.13	$34.62	1
Wyoming	17	$82.83	$51.22	1

Related codes

92014Established patient complete exam of visual system$124.11
92012Established patient problem focused exam of visual system$90.55
92083Exam of visual field$61.28
92004New patient complete exam of visual system$145.45
92020Exam of the internal drainage system of eye$27.92
92025Ct scan of cornea$34.33
92060Exam to measure eye deviation and range of motion$60.27
92082Exam of visual field$43.78
92081Exam of visual field$30.43
92065Eye training exercise performed by health care professional$39.76
92071Fitting of contact lens for treatment of eye surface disease$37.72
92066Eye training exercise under supervision of health care professional$26.12

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.