How much does Medicare pay for CPT 92004?

Medicare allowed an average of $145.45 per service and paid $95.18 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $256.76, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92004?

New patient complete exam of visual system. It was billed 1,523,496 times to 1,523,325 Medicare beneficiaries by 25,728 providers in 2024.

Does 92004 pay differently in an office than a hospital?

Yes. The allowed amount averaged $146.62 in an office setting and $94.04 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 92004 most?

Optometry, with 786,603 services from 16,484 clinicians. Next are Ophthalmology, Physician Assistant, General Practice.

CPT 92004

New patient complete exam of visual system

$145.45Medicare-allowed amount per service, averaged across 1,523,496 services

Providers submitted

$256.76

Asking price, not received

Medicare allowed

$145.45

The fee schedule figure

Medicare paid

$95.18

Balance is patient coinsurance

Providers submitted an average of $256.76 for this code and Medicare allowed $145.45 — 1.8× 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 $95.18 (65%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $146.62
Hospital / facility: $94.04

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. 1,489,813 services were billed in an office setting and 33,683 in a facility.

Services: 1,523,496
Beneficiaries: 1,523,325
Providers billing it: 25,728
Total allowed: $221,592,493

What Medicare pays for CPT 92004

Across 1,523,496 services billed by 25,728 providers to 1,523,325 beneficiaries, Medicare allowed an average of $145.45 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 92004

Specialty	Services	Beneficiaries	Avg allowed	Providers
Optometry	786,603	786,505	$142.12	16,484
Ophthalmology	734,396	734,324	$149.05	9,202
Physician Assistant	751	751	$117.12	14
General Practice	655	654	$169.84	3
Nurse Practitioner	456	456	$119.67	8
Neurology	183	183	$136.60	5
Internal Medicine	146	146	$126.11	4
Pediatric Medicine	137	137	$143.90	1
Maxillofacial Surgery	41	41	$150.34	1
Unknown Supplier/Provider Specialty	41	41	$138.23	2
Family Practice	37	37	$141.52	1
Gastroenterology	28	28	$149.82	1
Plastic and Reconstructive Surgery	11	11	$140.29	1
Clinic or Group Practice	11	11	$158.09	1

92004 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
California	157,902	$159.57	$97.25	1,898
Florida	131,114	$143.13	$97.21	1,694
New York	130,996	$159.14	$100.07	1,709
Texas	121,235	$141.61	$94.21	2,003
New Jersey	61,815	$159.88	$100.65	893
Illinois	60,348	$144.68	$94.37	957
Massachusetts	52,385	$150.34	$91.82	888
Pennsylvania	51,750	$143.15	$96.43	981
Georgia	40,329	$139.76	$95.60	654
Virginia	38,095	$145.65	$92.57	666
Arizona	35,506	$143.39	$94.19	512
Ohio	35,353	$132.65	$91.60	861
Maryland	32,278	$153.71	$95.54	461
Washington	32,020	$148.65	$89.35	583
Tennessee	31,305	$136.53	$96.60	601
Michigan	28,815	$138.74	$92.46	642
North Carolina	27,278	$138.83	$94.24	572
South Carolina	25,965	$137.83	$93.96	438
Missouri	24,734	$136.39	$93.95	514
Colorado	23,451	$145.32	$89.76	464
Wisconsin	22,196	$132.91	$86.34	505
Oklahoma	21,980	$133.77	$94.03	417
Louisiana	21,560	$133.06	$93.66	375
Mississippi	21,486	$131.41	$96.19	309
Minnesota	21,333	$142.03	$88.44	575
Indiana	21,319	$137.26	$93.88	490
Kansas	20,019	$136.39	$90.61	413
Arkansas	19,158	$131.35	$94.75	293
Iowa	17,836	$135.20	$91.48	404
Connecticut	17,695	$154.63	$96.91	392
Oregon	16,422	$145.68	$88.86	325
Kentucky	15,275	$133.15	$96.13	318
Alabama	13,440	$133.17	$96.47	294
Nevada	12,137	$143.65	$92.78	235
Utah	11,841	$134.21	$86.38	244
New Mexico	11,779	$136.32	$87.81	158
Nebraska	11,348	$135.79	$91.15	209
Idaho	9,736	$137.65	$91.20	174
New Hampshire	8,983	$146.43	$88.10	173
South Dakota	8,377	$140.79	$90.71	167
Maine	7,390	$139.43	$86.15	189
Montana	7,163	$143.48	$85.70	150
West Virginia	6,825	$132.95	$90.56	140
Vermont	5,996	$139.06	$85.48	77
North Dakota	5,201	$132.78	$82.26	133
Delaware	4,655	$146.23	$92.77	91
Rhode Island	4,555	$148.50	$95.99	109
Hawaii	3,826	$154.01	$84.32	105
Wyoming	3,793	$143.37	$83.96	77
Alaska	2,969	$168.02	$81.18	75
Puerto Rico	2,084	$144.60	$91.09	76
District of Columbia	1,355	$154.52	$96.94	23
Guam	409	$154.10	$74.11	8
U.S. Virgin Islands	281	$145.64	$74.86	7
Northern Mariana Islands	133	$158.16	$68.80	3
AA	114	$138.58	$91.50	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
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
92002New patient problem focused exam of visual system$84.57
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.