How much does Medicare pay for CPT 92286?

Medicare allowed an average of $38.45 per service and paid $28.49 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $169.90, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92286?

Imaging of front third of eye using a special microscope. It was billed 96,492 times to 85,706 Medicare beneficiaries by 1,175 providers in 2024.

Does 92286 pay differently in an office than a hospital?

Yes. The allowed amount averaged $38.65 in an office setting and $24.07 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 92286 most?

Ophthalmology, with 65,485 services from 813 clinicians. Next are Optometry, Physician Assistant, Nurse Practitioner.

CPT 92286

Imaging of front third of eye using a special microscope

$38.45Medicare-allowed amount per service, averaged across 96,492 services

Providers submitted

$169.90

Asking price, not received

Medicare allowed

$38.45

The fee schedule figure

Medicare paid

$28.49

Balance is patient coinsurance

Providers submitted an average of $169.90 for this code and Medicare allowed $38.45 — 4.4× 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 $28.49 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $38.65
Hospital / facility: $24.07

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. 95,159 services were billed in an office setting and 1,333 in a facility.

Services: 96,492
Beneficiaries: 85,706
Providers billing it: 1,175
Total allowed: $3,710,117

What Medicare pays for CPT 92286

Across 96,492 services billed by 1,175 providers to 85,706 beneficiaries, Medicare allowed an average of $38.45 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 92286

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	65,485	58,430	$39.12	813
Optometry	30,868	27,137	$37.07	359
Physician Assistant	125	125	$31.06	2
Nurse Practitioner	14	14	$30.16	1

92286 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	33,302	$41.55	$27.74	255
Florida	9,409	$37.58	$27.53	128
California	7,448	$41.25	$26.82	81
Texas	6,304	$36.73	$26.45	103
New Jersey	5,455	$40.66	$27.20	65
North Carolina	2,576	$29.83	$22.93	21
Pennsylvania	2,394	$37.01	$26.99	53
Massachusetts	2,179	$35.61	$23.28	31
Indiana	1,987	$36.00	$27.65	20
Maryland	1,796	$42.62	$27.20	18
Tennessee	1,775	$35.28	$26.31	27
Kansas	1,609	$35.00	$27.14	20
Arizona	1,468	$26.78	$19.75	24
Missouri	1,445	$34.94	$26.45	22
Georgia	1,345	$34.51	$25.72	24
Michigan	1,204	$37.01	$26.34	20
Alabama	1,189	$33.88	$26.84	11
Iowa	1,166	$31.92	$22.56	16
Illinois	1,159	$37.00	$26.27	25
Hawaii	1,000	$41.26	$29.06	10
Minnesota	982	$37.28	$26.40	16
Ohio	908	$30.95	$22.21	14
Arkansas	857	$25.52	$21.22	6
South Carolina	792	$36.10	$27.68	12
Oklahoma	773	$35.40	$27.66	12
Delaware	613	$38.05	$27.55	9
Virginia	609	$37.41	$27.95	15
Nebraska	536	$35.46	$26.99	10
Washington	503	$36.62	$23.77	9
Mississippi	425	$33.48	$26.77	10
Connecticut	350	$39.56	$25.95	9
Oregon	322	$37.78	$24.72	8
South Dakota	322	$36.49	$27.64	10
Colorado	246	$35.06	$24.49	7
Wisconsin	241	$32.83	$23.94	8
Utah	234	$33.38	$25.92	6
Puerto Rico	231	$35.57	$24.68	2
Louisiana	228	$35.32	$28.14	5
District of Columbia	218	$40.98	$26.64	4
New Hampshire	193	$35.16	$24.72	3
Kentucky	167	$35.88	$27.50	8
Idaho	167	$36.92	$26.74	5
New Mexico	84	$38.37	$28.69	4
West Virginia	78	$35.73	$27.24	2
Montana	61	$38.53	$28.00	2
North Dakota	55	$37.92	$28.41	1
Maine	42	$27.82	$19.05	2
Nevada	34	$39.72	$27.62	1
Rhode Island	11	$39.51	$27.71	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
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.