How much does Medicare pay for CPT 92250?

Medicare allowed an average of $35.91 per service and paid $25.43 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $119.35, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92250?

Photography of the retina. It was billed 3,413,264 times to 3,058,962 Medicare beneficiaries by 25,483 providers in 2024.

Does 92250 pay differently in an office than a hospital?

Yes. The allowed amount averaged $36.04 in an office setting and $20.94 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 92250 most?

Ophthalmology, with 1,711,037 services from 8,359 clinicians. Next are Optometry, Physician Assistant, Family Practice.

CPT 92250

Photography of the retina

$35.91Medicare-allowed amount per service, averaged across 3,413,264 services

Providers submitted

$119.35

Asking price, not received

Medicare allowed

$35.91

The fee schedule figure

Medicare paid

$25.43

Balance is patient coinsurance

Providers submitted an average of $119.35 for this code and Medicare allowed $35.91 — 3.3× 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 $25.43 (71%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $36.04
Hospital / facility: $20.94

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. 3,383,289 services were billed in an office setting and 29,975 in a facility.

Services: 3,413,264
Beneficiaries: 3,058,962
Providers billing it: 25,483
Total allowed: $122,570,310

What Medicare pays for CPT 92250

Across 3,413,264 services billed by 25,483 providers to 3,058,962 beneficiaries, Medicare allowed an average of $35.91 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 92250

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	1,711,037	1,469,897	$36.93	8,359
Optometry	1,681,703	1,571,524	$34.96	16,647
Physician Assistant	5,899	4,066	$22.01	45
Family Practice	4,813	4,591	$33.55	189
Internal Medicine	3,184	3,023	$33.26	132
Neurology	2,740	2,297	$31.85	25
Nurse Practitioner	2,612	2,334	$29.29	53
Cardiology	326	325	$41.95	2
Endocrinology	313	301	$33.99	14
Osteopathic Manipulative Medicine	273	245	$33.27	1
General Practice	159	159	$36.77	6
Diagnostic Radiology	60	60	$14.82	2
Gastroenterology	36	33	$36.64	1
Infectious Disease	32	32	$34.60	1
Pediatric Medicine	25	23	$30.31	2

92250 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	372,993	$39.67	$25.26	2,208
New York	304,783	$39.04	$25.49	1,702
Florida	303,233	$35.65	$25.67	1,503
Texas	221,116	$34.71	$25.24	1,866
New Jersey	172,176	$39.23	$25.87	967
Pennsylvania	148,921	$35.00	$24.86	1,279
North Carolina	124,609	$33.45	$24.64	858
Illinois	119,901	$35.54	$24.63	953
Virginia	112,274	$35.91	$24.84	705
Maryland	88,515	$38.00	$25.32	481
Michigan	76,751	$34.24	$24.73	741
Georgia	74,246	$34.25	$25.23	637
Ohio	71,920	$33.61	$24.67	751
Arizona	68,634	$34.87	$24.66	493
Massachusetts	67,918	$37.13	$24.41	596
Tennessee	67,902	$33.25	$25.31	579
Washington	63,589	$37.50	$24.51	602
South Carolina	62,395	$34.06	$25.24	412
Louisiana	58,698	$30.95	$23.71	332
Missouri	55,470	$33.15	$24.46	518
Oklahoma	53,343	$32.27	$24.39	427
Colorado	53,053	$36.18	$24.45	502
Indiana	51,471	$33.41	$24.59	556
Kansas	49,285	$32.54	$23.75	355
Connecticut	47,280	$38.24	$25.55	428
Iowa	45,254	$33.56	$24.57	355
Arkansas	40,158	$31.72	$24.60	331
Alabama	36,256	$31.93	$24.91	394
Mississippi	34,678	$30.55	$23.81	231
Kentucky	32,556	$33.26	$25.09	363
Hawaii	30,876	$38.18	$24.03	186
New Hampshire	27,230	$36.16	$23.76	179
Nebraska	26,368	$33.41	$24.17	207
Nevada	23,988	$35.37	$24.87	206
Wisconsin	21,582	$33.48	$23.26	284
Oregon	20,133	$35.78	$24.19	285
Utah	18,238	$32.92	$23.69	187
Minnesota	18,039	$35.21	$23.84	308
Idaho	17,314	$33.69	$23.80	177
West Virginia	13,261	$31.89	$23.62	137
Rhode Island	12,775	$36.62	$24.99	148
Maine	12,757	$34.62	$23.86	146
District of Columbia	12,648	$40.14	$25.48	42
Montana	11,457	$34.55	$22.40	118
Delaware	10,632	$36.05	$24.85	83
Wyoming	9,429	$35.51	$22.89	79
North Dakota	9,245	$35.16	$23.63	114
South Dakota	8,530	$35.50	$24.36	120
Vermont	8,355	$34.95	$22.87	70
Alaska	7,224	$42.67	$23.00	83
New Mexico	7,062	$32.52	$23.89	94
Puerto Rico	4,013	$35.52	$24.39	86
Guam	1,283	$39.66	$23.07	5
U.S. Virgin Islands	706	$35.59	$19.93	6
Northern Mariana Islands	405	$37.96	$18.43	3
AP	150	$33.97	$23.99	1

Related codes

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
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.