How much does Medicare pay for CPT 92071?

Medicare allowed an average of $37.72 per service and paid $28.90 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $116.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92071?

Fitting of contact lens for treatment of eye surface disease. It was billed 11,389 times to 5,446 Medicare beneficiaries by 298 providers in 2024.

Does 92071 pay differently in an office than a hospital?

Yes. The allowed amount averaged $37.86 in an office setting and $34.93 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 92071 most?

Ophthalmology, with 8,515 services from 203 clinicians. Next are Optometry, Physician Assistant.

CPT 92071

Fitting of contact lens for treatment of eye surface disease

$37.72Medicare-allowed amount per service, averaged across 11,389 services

Providers submitted

$116.72

Asking price, not received

Medicare allowed

$37.72

The fee schedule figure

Medicare paid

$28.90

Balance is patient coinsurance

Providers submitted an average of $116.72 for this code and Medicare allowed $37.72 — 3.1× 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 $28.90 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $37.86
Hospital / facility: $34.93

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. 10,842 services were billed in an office setting and 547 in a facility.

Services: 11,389
Beneficiaries: 5,446
Providers billing it: 298
Total allowed: $429,593

What Medicare pays for CPT 92071

Across 11,389 services billed by 298 providers to 5,446 beneficiaries, Medicare allowed an average of $37.72 per service. That is 2.1 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 92071

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	8,515	3,828	$37.60	203
Optometry	2,854	1,607	$38.07	94
Physician Assistant	20	11	$36.90	1

92071 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
Florida	1,647	$36.43	$28.35	35
Texas	1,570	$39.82	$31.03	29
California	1,278	$39.64	$27.77	34
New York	1,005	$40.79	$28.02	17
Tennessee	671	$36.86	$31.07	16
Illinois	628	$37.57	$27.89	14
Arizona	370	$36.03	$28.54	12
Pennsylvania	267	$35.62	$27.54	8
Nevada	262	$36.36	$28.42	8
New Jersey	248	$40.29	$29.02	5
Virginia	246	$34.96	$27.18	10
Kansas	244	$34.09	$26.75	9
Michigan	239	$36.34	$26.80	7
Oklahoma	218	$33.66	$27.59	6
North Carolina	197	$36.03	$28.01	9
Connecticut	195	$41.08	$29.88	5
Montana	149	$37.46	$26.61	1
Maryland	146	$38.79	$27.60	4
Ohio	141	$34.30	$25.35	6
Washington	128	$37.75	$27.58	6
Wisconsin	126	$37.36	$29.43	5
Louisiana	125	$34.40	$26.23	4
Minnesota	120	$33.83	$26.35	3
Massachusetts	117	$39.48	$27.61	4
Georgia	110	$37.64	$29.35	4
Kentucky	104	$37.67	$28.92	5
Missouri	92	$37.30	$29.08	4
Alabama	87	$34.40	$27.93	3
Oregon	85	$34.92	$27.10	3
Colorado	83	$36.12	$27.11	3
Mississippi	76	$37.91	$30.27	3
Indiana	57	$36.43	$28.25	2
Delaware	54	$35.57	$27.33	1
South Carolina	48	$34.32	$27.86	2
West Virginia	48	$33.68	$27.10	1
New Hampshire	39	$36.33	$25.87	2
North Dakota	38	$36.26	$25.59	2
South Dakota	35	$36.03	$26.75	2
Hawaii	27	$39.57	$27.70	1
New Mexico	27	$32.91	$28.70	1
Iowa	24	$33.92	$27.04	1
Utah	18	$35.63	$25.85	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
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
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.