FeeBase
Log inGet started
Menu

CPT code 92004: Comprehensive eye exam, new patient, one or more visits2026 Medicare rate & RVUs in Puerto Rico

Comprehensive medical eye evaluation for a new patient, with examination of the visual system and initiation of a diagnostic or treatment plan.

CMS RVU26DEffective Oct 1, 2026One payment locality1.6M Medicare services in 2024

In Puerto Rico, Medicare pays $150.58 for 92004 in the office and $77.98 when it’s performed in a hospital or facility.

$150.58Office (non-facility)
$77.98Hospital or facility
+0.6%vs the national office rate ($149.64)

Check a contract rate as a % of Medicare · 92004 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 92004 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 92004 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 92004 covers

A comprehensive new-patient eye evaluation includes the patient's history, general medical observation, external and ophthalmoscopic examinations, gross visual fields, and a basic sensorimotor examination. Slit lamp examination, tonometry, and dilation may be performed when indicated. The ophthalmologist or optometrist initiates a diagnostic or treatment plan based on the findings. The service is commonly performed in an office but may also be performed in a facility.

Report 92004 when the patient meets the new-patient definition and the documented service meets the comprehensive examination requirements rather than those for an intermediate examination. A patient is new if no professional service was received from the physician or another physician of the same specialty in the same group during the preceding three years. The evaluation may take one or more visits; report the completed service once. Record the examination findings and plan, and support the medical necessity of the visit. Refraction, when performed, is separately reported. Medicare prices 92004 as bilateral, so modifier 50 does not increase payment.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 92004

Across 109 of 109 payment localities, the office rate for 92004 runs from $136.65 in Arkansas to $194.38 in San Benito County, CA. Puerto Rico pays $150.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

92004 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$150.58
  2. Los Angeles, CA · California$167.69+$17.11
  3. Washington, DC area · District of Columbia$168.65+$18.07
  4. Miami, FL · Florida$155.27+$4.69
  5. Chicago, IL · Illinois$152.23+$1.65
  6. Manhattan, NY · New York$168.49+$17.91
  7. Alaska · Alaska$185.12+$34.54

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

92004 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$138.12$75.28
ArkansasArkansas$136.65$74.96
ArizonaArizona$146.73$77.15
Bakersfield, CACalifornia$158.67$79.96
Chico, CACalifornia$158.45$79.74
El Centro, CACalifornia$158.46$79.75
Fresno, CACalifornia$158.45$79.74
Hanford, CACalifornia$158.45$79.74

92004 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$136.65

$185.12

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
92004 office rate range by state
State / territoryOffice rate rangeLocalities
AK$185.121
AL$138.121
AR$136.651
AZ$146.731
CA$158.45–$194.3829
CO$155.671
CT$157.871
DC$168.651
DE$148.751
FL$146.46–$155.273
GA$140.44–$151.492
GU$161.061
HI$161.061
IA$141.391
ID$141.931
IL$142.77–$153.464
IN$142.561
KS$140.571
KY$139.811
LA$139.52–$144.652
MA$154.98–$168.962
MD$151.18–$168.653
ME$142.13–$148.362
MI$142.19–$147.492
MN$151.231
MO$137.52–$145.443
MS$137.121
MT$149.631
NC$143.291
ND$148.841
NE$142.071
NH$153.061
NJ$160.25–$167.562
NM$142.641
NV$149.501
NY$144.86–$171.215
OH$142.031
OK$139.971
OR$148.89–$159.982
PA$142.39–$154.582
PR$150.581
RI$153.531
SC$142.781
SD$148.751
TN$141.051
TX$141.67–$154.688
UT$144.251
VA$147.76–$168.652
VI$150.581
VT$148.101
WA$154.75–$172.302
WI$145.041
WV$138.751
WY$149.291

See 92004 in every payment locality

How the 92004 rate is calculated

Each of 92004’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 92004

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.82

1.82 RVUs× 1.000 GPCI

Practice expense2.62

2.62 RVUs× 1.000 GPCI

Malpractice0.04

0.04 RVUs× 1.000 GPCI

Adjusted RVUs

4.4800

Conversion factor

$33.4009

Medicare rate

$149.64

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,660

Code
92004
Physician work
1.82
Practice expense
2.62
Malpractice
0.04

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 92004 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.82× 1.0001.8200
Practice expense2.62× 1.0112.6488
Malpractice0.04× 0.9850.0394
Total RVUs4.5082
Conversion factor× 33.4009

Office rate, Puerto Rico$150.58

Office: (1.82 × 1 + 2.62 × 1.011 + 0.04 × 0.985) × $33.4009 = $150.58

Facility: (1.82 × 1 + 0.47 × 1.011 + 0.04 × 0.985) × $33.4009 = $77.98

Open 92004 in the RVU calculator

Payment rules and modifiers for 92004

The CMS indicators that decide how 92004 is paid alongside other services.

CMS payment indicators · 92004

Comprehensive eye exam, new patient, one or more visits

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)2Already bilateral by definition: paid once at 100%.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

Codes related to 92004

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 92004
CodeHow it relatesOffice range, Puerto Rico
Same family
92002Eye examination, intermediate, new patientIntermediate-level eye exam for a new patient.$85.43
92014Comprehensive eye exam, established patientComprehensive eye exam for an established patient.$128.10
92012Eye exam, intermediate, established patientIntermediate eye exam for an established patient.$91.15
Often billed with
92015RefractionRefraction may be performed at the same visit and is reported separately.No office rate
92083Visual field exam, extended visual field testingExtended visual field testing may accompany a new-patient glaucoma evaluation when performed that day.$64.30
92020GonioscopyGonioscopy may accompany a new-patient glaucoma or narrow-angle evaluation when performed that day.$26.87
Used instead
92018Eye examination, comprehensive, under anesthesiaComprehensive eye examination under general anesthesia when the examination requires that circumstance.No office rate
99203New patient visit, low MDM or 30 minutesNew-patient office E/M code that may describe the encounter instead of an ophthalmological examination code.$118.14

How 92004 has changed in Puerto Rico

92004 · Office / nonfacility

$150.58

Effective 2026-10-01

The base rate is $7.05 higher than on 2025-10-01, moving from $143.53 to $150.58 (4.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $143.53changed to$150.58

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 2.56 changed to 2.62
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $149.04changed to$143.53

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.59 changed to 2.56
    • Malpractice RVU 0.05 changed to 0.04

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $146.60changed to$149.04

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $151.14changed to$146.60

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.58 changed to 2.59
    • Malpractice RVU 0.04 changed to 0.05
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $150.46changed to$151.14

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $152.59changed to$150.46

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.52 changed to 2.58
    • Malpractice RVU 0.05 changed to 0.04
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $153.16changed to$152.59

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.50 changed to 2.52

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $153.32changed to$153.16

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.36 changed to 2.50
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $154.10changed to$153.32

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.37 changed to 2.36
    • Malpractice RVU 0.07 changed to 0.05
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $154.29changed to$154.10

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.38 changed to 2.37

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $137.90changed to$154.29

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.31 changed to 2.38
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $123.70changed to$137.90

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.29 changed to 2.31
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $124.04changed to$123.70

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.06 changed to 0.07

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $123.43changed to$124.04

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $123.03changed to$123.43

    • Conversion factor 35.8228 changed to 35.7547
    • Malpractice RVU 0.11 changed to 0.06
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $120.84changed to$123.03

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.51 changed to 2.29
    • Malpractice RVU 0.12 changed to 0.11
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $120.84

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$150.58$77.98RVU26D
2026-07-01$150.58$77.98RVU26C
2026-04-01$150.58$77.98RVU26B
2026-01-01$150.58$77.98RVU26A
2025-10-01$143.53$89.46RVU25D
2025-07-01$143.53$89.46RVU25C
2025-04-01$143.53$89.46RVU25B
2025-01-01$143.53$89.46RVU25A
2024-10-01$149.04$92.39RVU24D
2024-07-01$149.04$92.39RVU24C
2024-04-01$149.04$92.39RVU24B
2024-03-09$149.04$92.39RVU24AR
2024-01-01$146.60$90.88RVU24A
2023-10-01$151.14$94.09RVU23D
2023-07-01$150.46$93.87RVU23C
2023-04-01$150.46$93.87RVU23B
2023-01-01$150.46$93.87RVU23A
2022-10-01$152.59$96.08RVU22D
2022-07-01$152.59$96.08RVU22C
2022-04-01$152.59$96.08RVU22B
2022-01-01$152.59$96.08RVU22A
2021-10-01$153.16$96.88RVU21D
2021-07-01$153.16$96.88RVU21C
2021-04-01$153.16$96.88RVU21B
2021-01-01$153.16$96.88RVU21A
2020-10-01$153.32$100.21RVU20D
2020-07-01$153.32$100.21RVU20C
2020-04-01$153.32$100.21RVU20B
2020-01-01$153.32$100.21RVU20A
2019-10-01$154.10$101.48RVU19D
2019-07-01$154.10$101.48RVU19C
2019-04-01$154.10$101.48RVU19B
2019-01-01$154.10$101.48RVU19A
2018-10-01$154.29$101.73RVU18D
2018-07-01$154.29$101.73RVU18C
2018-04-01$154.29$101.73RVU18B
2018-01-01$154.29$101.73RVU18AR1
2017-10-01$137.90$95.81RVU17D
2017-07-01$137.90$95.81RVU17C
2017-04-01$137.90$95.81RVU17B
2017-01-01$137.90$95.81RVU17A
2016-10-01$123.70$89.37RVU16D
2016-07-01$123.70$89.37RVU16C
2016-04-01$123.70$89.37RVU16B
2016-01-01$123.70$89.37RVU16A
2015-10-01$124.04$89.59RVU15D
2015-07-01$124.04$89.59RVU15C
2015-04-01$123.43$89.14RVU15B
2015-01-01$123.43$89.14RVU15A
2014-10-01$123.03$89.57RVU14D
2014-07-01$123.03$89.57RVU14C
2014-04-01$123.03$89.57RVU14B
2014-01-01$123.03$89.57RVU14A
2013-10-01$120.84$86.01RVU13D
2013-07-01$120.84$86.01RVU13C
2013-04-01$120.84$86.01RVU13B
2013-01-01$120.84$86.01RVU13AR

Price 92004 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

92004 billing questions

When should 92004 be chosen over 92002?

Choose 92004 when the documented new-patient service meets the comprehensive examination requirements, including ophthalmoscopy and initiation of a diagnostic or treatment plan. Choose 92002 for an intermediate new-patient examination.

Is refraction included in 92004?

No. When performed and documented, determination of refractive state is reported separately with 92015. Medicare generally excludes refraction from coverage.

Should modifier 50 or RT/LT be appended?

Do not append modifier 50 to seek bilateral payment: 92004 is already priced as bilateral. An RT or LT modifier does not create a second payable eye examination.

Can 92004 and a new-patient E/M code be billed on the same day?

Do not report both for the same evaluation by the same provider. Select the code that describes the documented encounter; a genuinely separate E/M service requires its own supporting documentation and must meet applicable billing rules.

What if the comprehensive exam takes two visits?

The comprehensive service may span more than one visit, such as when a patient returns to complete the examination. Report 92004 once when the service is complete.

Are dilation and tonometry billed separately?

No. Dilation and tonometry performed as part of the comprehensive examination are not separately reported. A distinct diagnostic test, such as medically necessary visual field testing, may be reported separately when performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 92004PPRRVU2026_Oct_nonQPP.csv, line 11,660 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 92004 pays in Puerto Rico?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 92004 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist