How much does Medicare pay for CPT 92012?

Medicare allowed an average of $90.55 per service and paid $63.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $167.59, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92012?

Established patient problem focused exam of visual system. It was billed 3,111,523 times to 2,001,962 Medicare beneficiaries by 15,822 providers in 2024.

Does 92012 pay differently in an office than a hospital?

Yes. The allowed amount averaged $90.92 in an office setting and $50.06 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 92012 most?

Ophthalmology, with 2,290,060 services from 8,362 clinicians. Next are Optometry, Physician Assistant, Nurse Practitioner.

CPT 92012

Established patient problem focused exam of visual system

$90.55Medicare-allowed amount per service, averaged across 3,111,523 services

Providers submitted

$167.59

Asking price, not received

Medicare allowed

$90.55

The fee schedule figure

Medicare paid

$63.93

Balance is patient coinsurance

Providers submitted an average of $167.59 for this code and Medicare allowed $90.55 — 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 $63.93 (71%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $90.92
Hospital / facility: $50.06

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. 3,083,326 services were billed in an office setting and 28,197 in a facility.

Services: 3,111,523
Beneficiaries: 2,001,962
Providers billing it: 15,822
Total allowed: $281,748,408

What Medicare pays for CPT 92012

Across 3,111,523 services billed by 15,822 providers to 2,001,962 beneficiaries, Medicare allowed an average of $90.55 per service. That is 1.6 services per beneficiary, so this is a code patients typically receive more than once. 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 92012

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	2,290,060	1,397,454	$91.72	8,362
Optometry	816,245	600,565	$87.34	7,409
Physician Assistant	2,215	1,709	$69.61	22
Nurse Practitioner	1,101	848	$69.70	8
Plastic and Reconstructive Surgery	475	319	$95.43	4
General Practice	452	358	$108.28	2
Internal Medicine	298	217	$80.89	4
Pathology	189	125	$47.25	1
Family Practice	126	82	$84.33	1
Unknown Supplier/Provider Specialty	125	90	$88.07	1
Gastroenterology	107	81	$89.42	1
Pediatric Medicine	59	45	$83.09	3
Clinic or Group Practice	32	31	$95.21	1
Neurology	26	26	$67.45	2
Otolaryngology	13	12	$88.16	1

92012 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	501,718	$99.82	$62.39	1,568
New York	376,510	$97.95	$62.99	1,551
Florida	275,388	$87.23	$62.64	1,086
Texas	274,013	$85.59	$60.30	1,609
New Jersey	202,902	$97.33	$62.85	758
Pennsylvania	184,006	$88.88	$60.97	839
Illinois	113,593	$86.58	$59.42	635
Massachusetts	96,667	$92.95	$60.54	543
Virginia	74,219	$88.68	$59.89	411
Connecticut	64,340	$94.06	$62.14	281
Maryland	63,090	$95.16	$61.08	320
Louisiana	62,628	$79.91	$60.26	327
Georgia	56,201	$83.52	$60.60	329
South Carolina	46,121	$83.47	$60.53	212
Michigan	45,580	$83.97	$60.21	382
Arizona	44,244	$85.67	$61.13	245
Ohio	40,419	$80.05	$59.47	270
Missouri	39,669	$83.02	$59.82	270
Tennessee	39,027	$80.39	$60.21	347
North Carolina	35,775	$82.68	$59.12	260
Mississippi	34,285	$78.13	$60.13	191
Kansas	33,250	$80.84	$58.01	227
Arkansas	31,967	$77.77	$59.92	191
Washington	31,461	$94.34	$60.72	190
Oklahoma	25,812	$79.98	$59.47	181
Minnesota	25,804	$88.61	$59.59	178
Hawaii	25,224	$93.88	$58.40	135
Colorado	22,857	$86.35	$58.73	188
Iowa	21,117	$80.91	$57.28	202
Oregon	16,153	$87.65	$57.94	134
Indiana	14,984	$82.37	$59.73	120
Utah	14,331	$78.75	$55.99	150
Alabama	13,972	$79.62	$60.70	109
New Hampshire	12,996	$88.76	$60.23	77
Maine	12,652	$82.10	$55.88	126
Nebraska	11,639	$82.15	$58.76	83
Delaware	11,492	$87.36	$60.42	42
Idaho	11,465	$82.41	$59.09	69
Nevada	11,295	$87.35	$59.57	72
Wisconsin	11,286	$79.11	$55.29	148
New Mexico	10,953	$81.06	$59.14	74
Puerto Rico	10,884	$85.67	$58.76	142
Kentucky	10,063	$79.93	$58.25	92
South Dakota	9,779	$86.17	$59.58	85
West Virginia	8,899	$78.05	$56.99	62
Montana	8,034	$85.59	$59.12	50
Rhode Island	7,115	$87.53	$60.51	82
Vermont	4,218	$86.48	$58.94	42
North Dakota	3,483	$84.05	$53.93	56
Alaska	2,117	$97.40	$52.90	32
District of Columbia	1,689	$95.34	$60.02	16
Wyoming	1,561	$87.03	$57.86	13
Northern Mariana Islands	801	$94.87	$54.09	3
U.S. Virgin Islands	762	$87.15	$52.67	8
Guam	580	$92.46	$59.98	6
ZZ	300	$83.64	$62.61	1

Related codes

92014Established patient complete exam of visual system$124.11
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
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.