How much does Medicare pay for CPT 92228?

Medicare allowed an average of $23.67 per service and paid $15.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $76.27, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92228?

Imaging of retina with remote review by physician. It was billed 5,747 times to 5,456 Medicare beneficiaries by 174 providers in 2024.

Does 92228 pay differently in an office than a hospital?

Yes. The allowed amount averaged $24.49 in an office setting and $16.26 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 92228 most?

Ophthalmology, with 1,874 services from 24 clinicians. Next are Family Practice, Optometry, Internal Medicine.

CPT 92228

Imaging of retina with remote review by physician

$23.67Medicare-allowed amount per service, averaged across 5,747 services

Providers submitted

$76.27

Asking price, not received

Medicare allowed

$23.67

The fee schedule figure

Medicare paid

$15.85

Balance is patient coinsurance

Providers submitted an average of $76.27 for this code and Medicare allowed $23.67 — 3.2× 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 $15.85 (67%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $24.49
Hospital / facility: $16.26

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. 5,172 services were billed in an office setting and 575 in a facility.

Services: 5,747
Beneficiaries: 5,456
Providers billing it: 174
Total allowed: $136,031

What Medicare pays for CPT 92228

Across 5,747 services billed by 174 providers to 5,456 beneficiaries, Medicare allowed an average of $23.67 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 92228

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	1,874	1,867	$21.63	24
Family Practice	1,397	1,364	$25.60	73
Optometry	1,323	1,308	$22.67	23
Internal Medicine	824	601	$27.76	32
Nurse Practitioner	186	173	$19.83	12
Physician Assistant	90	90	$22.46	6
General Practice	26	26	$22.33	2
Endocrinology	15	15	$28.05	1
Geriatric Psychiatry	12	12	$11.29	1

92228 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
Pennsylvania	1,629	$26.98	$17.61	18
California	630	$22.70	$13.42	20
Illinois	399	$27.81	$20.59	4
Louisiana	388	$15.28	$10.74	9
North Carolina	337	$16.17	$11.55	8
Texas	315	$23.20	$16.32	19
Maryland	203	$24.40	$16.04	7
Mississippi	194	$27.40	$22.20	10
Missouri	174	$14.96	$9.06	5
Georgia	170	$26.93	$20.31	12
New York	148	$28.71	$19.15	8
Massachusetts	146	$23.12	$14.09	6
Arkansas	113	$22.05	$16.11	5
Arizona	113	$25.90	$20.79	8
Ohio	103	$26.05	$17.09	2
Michigan	85	$24.34	$17.77	5
Delaware	82	$18.66	$12.68	3
New Mexico	76	$16.12	$10.37	2
Idaho	75	$19.05	$14.66	2
Florida	71	$20.09	$14.16	4
New Jersey	64	$28.68	$17.55	4
Washington	60	$15.38	$11.50	2
South Carolina	57	$26.56	$18.44	5
New Hampshire	48	$29.71	$21.27	2
Virginia	24	$28.68	$21.27	1
Colorado	19	$12.45	$9.56	1
Montana	12	$13.19	$10.43	1
Tennessee	12	$27.71	$19.62	1

Related codes

92250Photography of the retina$35.91
92202Extended exam of the back part of the eye$15.95
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
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.