How much does Medicare pay for CPT 92285?

Medicare allowed an average of $21.67 per service and paid $15.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $70.83, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92285?

Photography of content of eyes. It was billed 423,388 times to 343,121 Medicare beneficiaries by 4,075 providers in 2024.

Does 92285 pay differently in an office than a hospital?

Yes. The allowed amount averaged $22.03 in an office setting and $3.05 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 92285 most?

Ophthalmology, with 270,875 services from 2,249 clinicians. Next are Optometry, Plastic and Reconstructive Surgery, Neurology.

CPT 92285

Photography of content of eyes

$21.67Medicare-allowed amount per service, averaged across 423,388 services

Providers submitted

$70.83

Asking price, not received

Medicare allowed

$21.67

The fee schedule figure

Medicare paid

$15.93

Balance is patient coinsurance

Providers submitted an average of $70.83 for this code and Medicare allowed $21.67 — 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 $15.93 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $22.03
Hospital / facility: $3.05

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. 415,478 services were billed in an office setting and 7,910 in a facility.

Services: 423,388
Beneficiaries: 343,121
Providers billing it: 4,075
Total allowed: $9,174,818

What Medicare pays for CPT 92285

Across 423,388 services billed by 4,075 providers to 343,121 beneficiaries, Medicare allowed an average of $21.67 per service. That is 1.2 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 92285

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	270,875	224,044	$21.96	2,249
Optometry	145,287	113,055	$21.14	1,777
Plastic and Reconstructive Surgery	2,985	2,571	$22.07	17
Neurology	1,593	1,209	$25.75	4
Physician Assistant	1,566	1,375	$18.17	13
Nurse Practitioner	456	418	$19.76	5
General Surgery	301	159	$22.34	1
Otolaryngology	95	91	$21.40	3
Internal Medicine	88	80	$3.11	1
Family Practice	60	38	$20.62	1
Maxillofacial Surgery	35	35	$23.87	1
Pediatric Medicine	17	17	$18.53	1
Independent Diagnostic Testing Facility (IDTF)	16	16	$16.63	1
Osteopathic Manipulative Medicine	14	13	$22.02	1

92285 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	50,991	$24.07	$15.68	409
California	49,925	$24.90	$15.96	407
Florida	42,488	$21.53	$15.94	399
Texas	30,157	$20.74	$15.89	293
Illinois	17,614	$21.65	$15.08	161
New Jersey	16,936	$21.47	$14.33	141
North Carolina	15,472	$20.35	$15.77	136
Tennessee	14,311	$19.92	$16.04	120
Virginia	13,468	$20.62	$15.00	113
Massachusetts	11,808	$20.77	$13.73	102
Pennsylvania	10,830	$21.01	$15.66	116
Arizona	9,566	$21.48	$16.34	74
Washington	8,986	$21.90	$14.84	96
Michigan	8,591	$18.15	$13.74	105
Maryland	7,770	$24.43	$16.46	93
Georgia	7,641	$20.42	$15.41	86
Oklahoma	7,445	$19.95	$16.27	73
Louisiana	7,181	$19.33	$15.74	65
Kansas	5,904	$19.75	$15.83	46
Colorado	5,862	$21.14	$14.84	62
Missouri	5,706	$19.44	$15.14	66
Ohio	5,348	$20.12	$15.38	66
South Carolina	5,334	$20.28	$15.93	61
Alabama	5,108	$19.31	$16.57	49
Arkansas	4,870	$18.64	$15.67	43
Indiana	4,851	$18.67	$14.26	48
Iowa	4,793	$18.45	$13.88	66
Kentucky	4,243	$19.98	$16.04	36
Oregon	3,949	$20.23	$14.40	54
Minnesota	3,542	$21.65	$15.78	59
Utah	3,414	$19.99	$16.28	36
Connecticut	3,383	$24.65	$16.51	44
Nevada	3,332	$22.38	$16.36	29
Wisconsin	2,662	$18.29	$13.89	47
Hawaii	2,296	$24.70	$15.80	24
New Hampshire	2,157	$21.32	$15.14	17
Mississippi	2,085	$18.73	$15.80	26
Idaho	1,959	$19.40	$15.79	28
South Dakota	1,616	$22.16	$16.44	20
Maine	1,398	$21.32	$15.62	13
Nebraska	1,258	$19.52	$15.36	27
Delaware	1,225	$22.67	$17.24	10
Montana	1,115	$22.57	$15.64	14
District of Columbia	705	$26.98	$16.71	6
West Virginia	689	$17.57	$14.65	12
Puerto Rico	654	$22.20	$15.17	17
North Dakota	587	$18.90	$13.35	11
Rhode Island	541	$22.95	$15.82	10
New Mexico	399	$18.74	$15.27	12
Vermont	349	$19.85	$14.06	6
Alaska	333	$24.57	$15.97	10
Wyoming	267	$22.82	$16.15	6
Northern Mariana Islands	196	$25.33	$12.57	3
Guam	78	$25.07	$15.32	2

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
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.