How much does Medicare pay for CPT 92020?

Medicare allowed an average of $27.92 per service and paid $20.25 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $69.96, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92020?

Exam of the internal drainage system of eye. It was billed 664,399 times to 595,986 Medicare beneficiaries by 7,492 providers in 2024.

Does 92020 pay differently in an office than a hospital?

Yes. The allowed amount averaged $28.04 in an office setting and $20.39 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 92020 most?

Ophthalmology, with 554,802 services from 5,190 clinicians. Next are Optometry, Internal Medicine, Physician Assistant.

CPT 92020

Exam of the internal drainage system of eye

$27.92Medicare-allowed amount per service, averaged across 664,399 services

Providers submitted

$69.96

Asking price, not received

Medicare allowed

$27.92

The fee schedule figure

Medicare paid

$20.25

Balance is patient coinsurance

Providers submitted an average of $69.96 for this code and Medicare allowed $27.92 — 2.5× 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 $20.25 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $28.04
Hospital / facility: $20.39

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. 653,705 services were billed in an office setting and 10,694 in a facility.

Services: 664,399
Beneficiaries: 595,986
Providers billing it: 7,492
Total allowed: $18,550,020

What Medicare pays for CPT 92020

Across 664,399 services billed by 7,492 providers to 595,986 beneficiaries, Medicare allowed an average of $27.92 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 92020

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	554,802	494,050	$28.12	5,190
Optometry	108,421	100,838	$26.91	2,295
Internal Medicine	986	917	$26.30	4
Physician Assistant	141	139	$22.12	2
Pathology	49	42	$19.14	1

92020 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	99,745	$30.13	$19.77	745
California	98,483	$30.24	$19.73	747
Florida	53,606	$26.83	$19.40	556
New Jersey	47,651	$29.92	$19.79	378
Texas	36,166	$26.37	$19.18	425
Pennsylvania	36,048	$26.81	$18.90	408
Maryland	29,127	$28.88	$19.79	208
Illinois	26,441	$26.88	$18.98	268
Virginia	21,882	$27.05	$19.07	229
Ohio	17,808	$25.12	$18.29	268
Michigan	14,067	$26.33	$19.16	201
North Carolina	12,776	$25.82	$19.09	195
Arizona	11,885	$26.83	$19.35	134
Massachusetts	11,487	$27.77	$18.30	196
Georgia	10,311	$25.89	$19.20	192
Connecticut	10,216	$28.80	$19.14	125
Washington	9,591	$27.93	$18.64	173
South Carolina	8,054	$25.59	$18.69	122
Missouri	7,821	$25.39	$18.66	133
Tennessee	6,692	$25.16	$19.07	132
Indiana	6,594	$25.73	$18.94	126
Nevada	5,816	$26.76	$19.09	39
Kansas	5,357	$24.97	$18.74	74
Louisiana	5,184	$24.59	$18.70	79
Oklahoma	5,084	$25.31	$19.46	70
Hawaii	5,065	$28.57	$19.26	71
Alabama	4,715	$24.46	$19.20	74
Arkansas	4,545	$24.26	$19.01	77
Wisconsin	4,127	$24.80	$17.51	110
Oregon	4,029	$27.00	$18.94	89
Mississippi	3,942	$24.19	$19.27	70
New Hampshire	3,606	$27.09	$18.12	57
Minnesota	3,592	$26.93	$18.47	86
Colorado	3,400	$26.64	$18.45	74
Iowa	3,390	$25.22	$18.57	69
Kentucky	3,117	$25.22	$18.69	72
District of Columbia	2,879	$29.47	$19.66	23
Delaware	2,621	$26.83	$18.70	30
West Virginia	1,998	$24.23	$19.25	27
Nebraska	1,880	$25.18	$18.80	47
Maine	1,770	$25.67	$18.41	34
Rhode Island	1,674	$27.43	$19.43	36
New Mexico	1,626	$25.52	$18.15	36
South Dakota	1,437	$26.29	$18.79	30
Vermont	1,425	$24.65	$17.62	16
Montana	1,233	$26.33	$18.62	24
Utah	1,117	$25.14	$18.62	34
Puerto Rico	870	$26.68	$18.30	25
Alaska	766	$33.22	$18.22	22
North Dakota	760	$24.31	$17.52	7
Idaho	514	$25.12	$19.30	16
Wyoming	264	$26.22	$18.30	8
U.S. Virgin Islands	128	$26.09	$17.66	4
AA	17	$25.54	$21.40	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
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.