CPT code 92004: Comprehensive eye exam, new patient, one or more visits2026 Medicare rate & RVUs in South Carolina
Comprehensive medical eye evaluation for a new patient, with examination of the visual system and initiation of a diagnostic or treatment plan.
In South Carolina, Medicare pays $142.78 for 92004 in the office and $76.43 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 South Carolina 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. South Carolina pays $142.78. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Carolina · this page$142.78
- Los Angeles, CA · California$167.69+$24.91
- Washington, DC area · District of Columbia$168.65+$25.87
- Miami, FL · Florida$155.27+$12.49
- Chicago, IL · Illinois$152.23+$9.45
- Manhattan, NY · New York$168.49+$25.71
- Alaska · Alaska$185.12+$42.34
Other areas in South Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $158.45 | $79.74 |
| Merced, CACalifornia | $158.45 | $79.74 |
| Modesto, CACalifornia | $158.45 | $79.74 |
| Napa, CACalifornia | $180.64 | $85.99 |
| Oxnard, CACalifornia | $166.76 | $81.88 |
| Redding, CACalifornia | $158.45 | $79.74 |
| Rest of CaliforniaCalifornia | $158.45 | $79.74 |
| Riverside, CACalifornia | $158.93 | $80.23 |
| Sacramento, CACalifornia | $165.47 | $81.95 |
| Salinas, CACalifornia | $164.81 | $81.58 |
| San Diego, CACalifornia | $168.00 | $82.11 |
| Marin County, CACalifornia | $190.57 | $89.31 |
| San Francisco, CACalifornia | $190.52 | $89.27 |
| San Benito County, CACalifornia | $194.38 | $90.83 |
| Santa Clara County, CACalifornia | $194.20 | $90.64 |
| San Luis Obispo, CACalifornia | $162.21 | $80.42 |
| Santa Cruz, CACalifornia | $169.11 | $81.86 |
| Santa Maria, CACalifornia | $165.24 | $81.51 |
| Santa Rosa, CACalifornia | $170.79 | $82.61 |
| Stockton, CACalifornia | $158.45 | $79.74 |
| Vallejo, CACalifornia | $180.57 | $85.92 |
| Visalia, CACalifornia | $158.45 | $79.74 |
| Yuba City, CACalifornia | $158.45 | $79.74 |
| ColoradoColorado | $155.67 | $79.27 |
| ConnecticutConnecticut | $157.87 | $80.53 |
| DelawareDelaware | $148.75 | $77.80 |
| Fort Lauderdale, FLFlorida | $151.85 | $79.11 |
| Rest of FloridaFlorida | $146.46 | $77.81 |
| Atlanta, GAGeorgia | $151.49 | $78.53 |
| Rest of GeorgiaGeorgia | $140.44 | $76.39 |
| Hawaii, Guam, HIHawaii | $161.06 | $79.41 |
| IowaIowa | $141.39 | $75.68 |
| IdahoIdaho | $141.93 | $75.86 |
| East St. Louis, ILIllinois | $143.99 | $77.92 |
| Rest of IllinoisIllinois | $142.77 | $77.21 |
| Suburban Chicago, ILIllinois | $153.46 | $79.70 |
| IndianaIndiana | $142.56 | $75.99 |
| KansasKansas | $140.57 | $75.65 |
| KentuckyKentucky | $139.81 | $75.97 |
| New Orleans, LALouisiana | $144.65 | $77.08 |
| Rest of LouisianaLouisiana | $139.52 | $75.96 |
| Metropolitan Boston, MAMassachusetts | $168.96 | $83.22 |
| Rest of MassachusettsMassachusetts | $154.98 | $79.36 |
| Baltimore area, MDMaryland | $157.31 | $80.26 |
| Rest of MarylandMaryland | $151.18 | $78.51 |
| Rest of MaineMaine | $142.13 | $76.06 |
| Southern Maine, MEMaine | $148.36 | $77.19 |
| Detroit, MIMichigan | $147.49 | $78.19 |
| Rest of MichiganMichigan | $142.19 | $76.63 |
| MinnesotaMinnesota | $151.23 | $77.34 |
| Metropolitan Kansas City, MOMissouri | $144.27 | $76.84 |
| Metropolitan St. Louis, MOMissouri | $145.44 | $77.07 |
| Rest of MissouriMissouri | $137.52 | $75.62 |
| MississippiMississippi | $137.12 | $75.29 |
| MontanaMontana | $149.63 | $77.82 |
| North CarolinaNorth Carolina | $143.29 | $76.29 |
| North DakotaNorth Dakota | $148.84 | $77.03 |
| NebraskaNebraska | $142.07 | $75.78 |
| New HampshireNew Hampshire | $153.06 | $78.30 |
| Northern New JerseyNew Jersey | $167.56 | $84.26 |
| Rest of New JerseyNew Jersey | $160.25 | $81.83 |
| New MexicoNew Mexico | $142.64 | $76.79 |
| NevadaNevada | $149.50 | $77.62 |
| NYC suburbs and Long Island, NYNew York | $171.21 | $85.83 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $160.97 | $82.33 |
| Queens, NYNew York | $170.04 | $85.16 |
| Rest of New YorkNew York | $144.86 | $76.64 |
| OhioOhio | $142.03 | $76.47 |
| OklahomaOklahoma | $139.97 | $75.85 |
| Portland, OROregon | $159.98 | $80.20 |
| Rest of OregonOregon | $148.89 | $77.36 |
| Metropolitan Philadelphia, PAPennsylvania | $154.58 | $79.82 |
| Rest of PennsylvaniaPennsylvania | $142.39 | $76.46 |
| Puerto RicoPuerto Rico | $150.58 | $77.98 |
| Rhode IslandRhode Island | $153.53 | $79.35 |
| South DakotaSouth Dakota | $148.75 | $76.94 |
| TennesseeTennessee | $141.05 | $75.78 |
| Austin, TXTexas | $154.68 | $78.70 |
| Beaumont, TXTexas | $141.67 | $76.32 |
| Brazoria, TXTexas | $149.04 | $77.88 |
| Dallas, TXTexas | $149.64 | $78.12 |
| Fort Worth, TXTexas | $148.79 | $77.98 |
| Galveston, TXTexas | $149.28 | $77.97 |
| Houston, TXTexas | $150.01 | $78.70 |
| Rest of TexasTexas | $145.04 | $76.89 |
| UtahUtah | $144.25 | $76.75 |
| VirginiaVirginia | $147.76 | $77.16 |
| Virgin Islands, VIUnited States Virgin Islands | $150.58 | $77.98 |
| VermontVermont | $148.10 | $77.01 |
| Rest of WashingtonWashington | $154.75 | $79.13 |
| King County, WAWashington | $172.30 | $84.18 |
| WisconsinWisconsin | $145.04 | $76.24 |
| West VirginiaWest Virginia | $138.75 | $76.34 |
| WyomingWyoming | $149.29 | $77.48 |
92004 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $185.12 | 1 |
| AL | $138.12 | 1 |
| AR | $136.65 | 1 |
| AZ | $146.73 | 1 |
| CA | $158.45–$194.38 | 29 |
| CO | $155.67 | 1 |
| CT | $157.87 | 1 |
| DC | $168.65 | 1 |
| DE | $148.75 | 1 |
| FL | $146.46–$155.27 | 3 |
| GA | $140.44–$151.49 | 2 |
| GU | $161.06 | 1 |
| HI | $161.06 | 1 |
| IA | $141.39 | 1 |
| ID | $141.93 | 1 |
| IL | $142.77–$153.46 | 4 |
| IN | $142.56 | 1 |
| KS | $140.57 | 1 |
| KY | $139.81 | 1 |
| LA | $139.52–$144.65 | 2 |
| MA | $154.98–$168.96 | 2 |
| MD | $151.18–$168.65 | 3 |
| ME | $142.13–$148.36 | 2 |
| MI | $142.19–$147.49 | 2 |
| MN | $151.23 | 1 |
| MO | $137.52–$145.44 | 3 |
| MS | $137.12 | 1 |
| MT | $149.63 | 1 |
| NC | $143.29 | 1 |
| ND | $148.84 | 1 |
| NE | $142.07 | 1 |
| NH | $153.06 | 1 |
| NJ | $160.25–$167.56 | 2 |
| NM | $142.64 | 1 |
| NV | $149.50 | 1 |
| NY | $144.86–$171.21 | 5 |
| OH | $142.03 | 1 |
| OK | $139.97 | 1 |
| OR | $148.89–$159.98 | 2 |
| PA | $142.39–$154.58 | 2 |
| PR | $150.58 | 1 |
| RI | $153.53 | 1 |
| SC | $142.78 | 1 |
| SD | $148.75 | 1 |
| TN | $141.05 | 1 |
| TX | $141.67–$154.68 | 8 |
| UT | $144.25 | 1 |
| VA | $147.76–$168.65 | 2 |
| VI | $150.58 | 1 |
| VT | $148.10 | 1 |
| WA | $154.75–$172.30 | 2 |
| WI | $145.04 | 1 |
| WV | $138.75 | 1 |
| WY | $149.29 | 1 |
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
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 South Carolina 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
93
- Locality
- South Carolina
- Physician work
- 1.000
- Practice expense
- 0.924
- Malpractice
- 0.850
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.82 | × 1.000 | 1.8200 |
| Practice expense | 2.62 | × 0.924 | 2.4209 |
| Malpractice | 0.04 | × 0.850 | 0.0340 |
| Total RVUs | 4.2749 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Carolina$142.78
Office: (1.82 × 1 + 2.62 × 0.924 + 0.04 × 0.85) × $33.4009 = $142.78
Facility: (1.82 × 1 + 0.47 × 0.924 + 0.04 × 0.85) × $33.4009 = $76.43
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
How 92004 has changed in South Carolina
92004 · Office / nonfacility
$142.78
Effective 2026-10-01
The base rate is $7.25 higher than on 2025-10-01, moving from $135.53 to $142.78 (5.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$135.53changed to$142.78
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 2.56 changed to 2.62
- Practice expense GPCI 0.913 changed to 0.924
- Malpractice GPCI 0.817 changed to 0.850
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$140.66changed to$135.53
- 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.
March 9, 2024
RVU24AR
$138.36changed to$140.66
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$142.08changed to$138.36
- 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 0.908 changed to 0.913
- Malpractice GPCI 0.756 changed to 0.817
January 1, 2023
RVU23A
$142.93changed to$142.08
- 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 0.903 changed to 0.908
- Malpractice GPCI 0.695 changed to 0.756
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$143.49changed to$142.93
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.50 changed to 2.52
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$144.06changed to$143.49
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.36 changed to 2.50
- Practice expense GPCI 0.907 changed to 0.903
- Malpractice GPCI 0.624 changed to 0.695
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$144.88changed to$144.06
- 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 0.912 changed to 0.907
- Malpractice GPCI 0.553 changed to 0.624
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$145.05changed to$144.88
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.38 changed to 2.37
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$142.52changed to$145.05
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.31 changed to 2.38
- Malpractice GPCI 0.634 changed to 0.553
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$141.73changed to$142.52
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 2.29 changed to 2.31
- Malpractice GPCI 0.715 changed to 0.634
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$141.99changed to$141.73
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.06 changed to 0.07
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$141.28changed to$141.99
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$142.37changed to$141.28
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.11 changed to 0.06
- Practice expense GPCI 0.911 changed to 0.912
- Malpractice GPCI 0.618 changed to 0.715
Held through RVU15B.
January 1, 2014
RVU14A
$141.67changed to$142.37
- 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 0.909 changed to 0.911
- Malpractice GPCI 0.520 changed to 0.618
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $141.67
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $142.78 | $76.43 | RVU26D |
| 2026-07-01 | $142.78 | $76.43 | RVU26C |
| 2026-04-01 | $142.78 | $76.43 | RVU26B |
| 2026-01-01 | $142.78 | $76.43 | RVU26A |
| 2025-10-01 | $135.53 | $86.51 | RVU25D |
| 2025-07-01 | $135.53 | $86.51 | RVU25C |
| 2025-04-01 | $135.53 | $86.51 | RVU25B |
| 2025-01-01 | $135.53 | $86.51 | RVU25A |
| 2024-10-01 | $140.66 | $89.30 | RVU24D |
| 2024-07-01 | $140.66 | $89.30 | RVU24C |
| 2024-04-01 | $140.66 | $89.30 | RVU24B |
| 2024-03-09 | $140.66 | $89.30 | RVU24AR |
| 2024-01-01 | $138.36 | $87.84 | RVU24A |
| 2023-10-01 | $142.08 | $90.70 | RVU23D |
| 2023-07-01 | $142.08 | $90.70 | RVU23C |
| 2023-04-01 | $142.08 | $90.70 | RVU23B |
| 2023-01-01 | $142.08 | $90.70 | RVU23A |
| 2022-10-01 | $142.93 | $92.31 | RVU22D |
| 2022-07-01 | $142.93 | $92.31 | RVU22C |
| 2022-04-01 | $142.93 | $92.31 | RVU22B |
| 2022-01-01 | $142.93 | $92.31 | RVU22A |
| 2021-10-01 | $143.49 | $93.08 | RVU21D |
| 2021-07-01 | $143.49 | $93.08 | RVU21C |
| 2021-04-01 | $143.49 | $93.08 | RVU21B |
| 2021-01-01 | $143.49 | $93.08 | RVU21A |
| 2020-10-01 | $144.06 | $96.27 | RVU20D |
| 2020-07-01 | $144.06 | $96.27 | RVU20C |
| 2020-04-01 | $144.06 | $96.27 | RVU20B |
| 2020-01-01 | $144.06 | $96.27 | RVU20A |
| 2019-10-01 | $144.88 | $97.22 | RVU19D |
| 2019-07-01 | $144.88 | $97.22 | RVU19C |
| 2019-04-01 | $144.88 | $97.22 | RVU19B |
| 2019-01-01 | $144.88 | $97.22 | RVU19A |
| 2018-10-01 | $145.05 | $97.45 | RVU18D |
| 2018-07-01 | $145.05 | $97.45 | RVU18C |
| 2018-04-01 | $145.05 | $97.45 | RVU18B |
| 2018-01-01 | $145.05 | $97.45 | RVU18AR1 |
| 2017-10-01 | $142.52 | $97.68 | RVU17D |
| 2017-07-01 | $142.52 | $97.68 | RVU17C |
| 2017-04-01 | $142.52 | $97.68 | RVU17B |
| 2017-01-01 | $142.52 | $97.68 | RVU17A |
| 2016-10-01 | $141.73 | $97.32 | RVU16D |
| 2016-07-01 | $141.73 | $97.32 | RVU16C |
| 2016-04-01 | $141.73 | $97.32 | RVU16B |
| 2016-01-01 | $141.73 | $97.32 | RVU16A |
| 2015-10-01 | $141.99 | $97.42 | RVU15D |
| 2015-07-01 | $141.99 | $97.42 | RVU15C |
| 2015-04-01 | $141.28 | $96.93 | RVU15B |
| 2015-01-01 | $141.28 | $96.93 | RVU15A |
| 2014-10-01 | $142.37 | $98.31 | RVU14D |
| 2014-07-01 | $142.37 | $98.31 | RVU14C |
| 2014-04-01 | $142.37 | $98.31 | RVU14B |
| 2014-01-01 | $142.37 | $98.31 | RVU14A |
| 2013-10-01 | $141.67 | $94.97 | RVU13D |
| 2013-07-01 | $141.67 | $94.97 | RVU13C |
| 2013-04-01 | $141.67 | $94.97 | RVU13B |
| 2013-01-01 | $141.67 | $94.97 | RVU13AR |
Where the South Carolina rate applies
South Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 475 cities and communities in South Carolina. Some span more than one payment area; confirm with the service ZIP.
- Abbeville
- Abney Crossroads
- Adams Run
- Aiken
- Alcolu
- Allendale
- Anderson
- Andrews
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
Fee sheets
Put 92004 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet