How much does Medicare pay for CPT 92202?

Medicare allowed an average of $15.95 per service and paid $11.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $76.99, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92202?

Extended exam of the back part of the eye with optic nerve drawing. It was billed 642,246 times to 431,064 Medicare beneficiaries by 2,170 providers in 2024.

Does 92202 pay differently in an office than a hospital?

Yes. The allowed amount averaged $15.97 in an office setting and $14.96 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 92202 most?

Ophthalmology, with 599,549 services from 1,671 clinicians. Next are Optometry, Neurology, Internal Medicine.

CPT 92202

Extended exam of the back part of the eye with optic nerve drawing

$15.95Medicare-allowed amount per service, averaged across 642,246 services

Providers submitted

$76.99

Asking price, not received

Medicare allowed

$15.95

The fee schedule figure

Medicare paid

$11.85

Balance is patient coinsurance

Providers submitted an average of $76.99 for this code and Medicare allowed $15.95 — 4.8× 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 $11.85 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $15.97
Hospital / facility: $14.96

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. 632,106 services were billed in an office setting and 10,140 in a facility.

Services: 642,246
Beneficiaries: 431,064
Providers billing it: 2,170
Total allowed: $10,243,824

What Medicare pays for CPT 92202

Across 642,246 services billed by 2,170 providers to 431,064 beneficiaries, Medicare allowed an average of $15.95 per service. That is 1.5 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 92202

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	599,549	393,215	$15.98	1,671
Optometry	42,289	37,485	$15.54	496
Neurology	291	267	$15.64	2
Internal Medicine	117	97	$16.13	1

92202 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	124,329	$16.97	$11.20	524
California	67,093	$16.41	$11.06	224
New Jersey	61,722	$16.84	$11.30	203
Florida	60,408	$15.24	$10.93	195
Maryland	52,657	$16.30	$11.40	63
Virginia	38,316	$15.69	$11.22	60
Texas	38,058	$15.04	$11.31	97
Illinois	26,734	$15.45	$11.02	83
Missouri	25,733	$15.10	$10.98	59
Massachusetts	13,014	$15.83	$11.13	40
Indiana	11,612	$14.60	$10.74	57
Michigan	9,673	$14.92	$10.93	47
Pennsylvania	9,458	$15.40	$11.22	51
Ohio	9,181	$14.80	$10.86	37
Connecticut	9,122	$16.35	$10.88	42
North Carolina	8,486	$14.69	$11.08	34
Hawaii	8,075	$15.99	$11.28	17
Arizona	8,032	$15.33	$10.80	39
Washington	7,054	$16.32	$10.87	23
Oklahoma	4,701	$14.41	$11.42	11
Louisiana	4,684	$14.52	$11.02	26
New Mexico	4,044	$14.50	$10.74	12
Arkansas	3,738	$14.26	$10.48	9
Colorado	3,505	$15.90	$11.32	10
Utah	3,315	$14.86	$11.56	8
Puerto Rico	3,043	$14.99	$10.40	54
District of Columbia	2,806	$16.81	$11.36	4
Tennessee	2,734	$14.04	$10.85	21
Wisconsin	2,344	$14.57	$10.31	15
Georgia	1,944	$15.30	$10.94	8
Kentucky	1,903	$14.67	$11.12	13
Alabama	1,839	$14.01	$10.47	8
Nevada	1,817	$15.60	$10.88	8
Mississippi	1,793	$14.22	$10.22	6
Rhode Island	1,353	$15.31	$10.76	6
Montana	1,275	$15.89	$11.11	2
Oregon	1,177	$15.24	$11.12	7
Delaware	1,078	$14.99	$10.73	4
New Hampshire	936	$15.42	$11.11	6
Minnesota	738	$15.62	$11.22	2
Vermont	393	$14.85	$10.11	5
Wyoming	368	$15.03	$8.91	4
Iowa	367	$14.65	$10.12	7
Kansas	314	$14.84	$10.93	3
Maine	312	$15.09	$10.93	3
Idaho	292	$14.87	$9.02	2
West Virginia	242	$14.05	$11.67	1
South Carolina	206	$13.87	$10.97	5
Nebraska	196	$14.27	$11.34	3
North Dakota	21	$15.89	$12.01	1
Alaska	11	$20.16	$10.92	1

Related codes

92250Photography of the retina$35.91
92201Extended exam of the back part of the eye$25.70
92285Photography of content of eyes$21.67
92235Exam of retinal blood vessels$162.79
92273Measurement of retinal and optic nerve function$122.61
92286Imaging of front third of eye$38.45
92283Extended exam involving color vision testing$49.33
92284Evaluation of eye adaptation to light and dark$34.27
92242Exam of retinal blood vessels and blood vessels between the white part$289.54
92228Imaging of retina$23.67
92240Exam of blood vessels between the white part of eye and retina$181.64
92287Imaging of front third of eye$154.40

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.