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CPT code 92012: Eye exam, intermediate, established patient2026 Medicare rate & RVUs in North Carolina

An intermediate ophthalmological exam is reported when an ophthalmologist or optometrist evaluates a defined eye concern in an established patient without performing a comprehensive exam.

CMS RVU26DEffective Oct 1, 2026One payment locality3.2M Medicare services in 2024

In North Carolina, Medicare pays $86.22 for 92012 in the office and $40.41 when it’s performed in a hospital or facility.

$86.22Office (non-facility)
$40.41Hospital or facility
−4.8%vs the national office rate ($90.52)

Check a contract rate as a % of Medicare · 92012 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 92012 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 92012 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 92012 covers

An intermediate ophthalmological examination addresses a defined eye concern or interval reassessment in a returning patient. The ophthalmologist or optometrist obtains an interval history, makes general medical observations, examines the external eye and surrounding structures, and performs other diagnostic steps as indicated. The examination may involve one eye or both and may include dilation when needed. The clinician establishes or updates a diagnostic and treatment plan based on the findings. This service is commonly furnished in an office or outpatient eye clinic.

Report 92012 when the patient qualifies as established and the documented examination supports an intermediate rather than comprehensive ophthalmological service. Record the presenting concern, pertinent history, examined structures, findings, and diagnostic and treatment plan. A comprehensive evaluation of the visual system is reported with 92014 instead. Refraction, if performed, is reported separately with 92015. Medically necessary visual field or retinal imaging tests require separate documentation to support reporting them alongside the exam. CMS prices 92012 as bilateral, so examining both eyes does not support two units, and 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 North Carolina compares for 92012

Across 109 of 109 payment localities, the office rate for 92012 runs from $81.74 in Arkansas to $119.41 in San Benito County, CA. North Carolina pays $86.22. The RVUs are the same everywhere; the geographic indexes change the dollars.

92012 in North Carolina vs other payment areas
  1. North Carolina · this page$86.22
  2. Los Angeles, CA · California$102.20+$15.98
  3. Washington, DC area · District of Columbia$102.75+$16.53
  4. Miami, FL · Florida$94.46+$8.24
  5. Chicago, IL · Illinois$92.32+$6.10
  6. Manhattan, NY · New York$102.59+$16.37
  7. Alaska · Alaska$109.25+$23.03

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

92012 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$82.73$39.77
ArkansasArkansas$81.74$39.57
ArizonaArizona$88.55$40.97
Bakersfield, CACalifornia$96.35$42.54
Chico, CACalifornia$96.22$42.40
El Centro, CACalifornia$96.22$42.41
Fresno, CACalifornia$96.22$42.40
Hanford, CACalifornia$96.22$42.40

92012 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.

$81.74

$109.25

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

View every state and territory as a table
92012 office rate range by state
State / territoryOffice rate rangeLocalities
AK$109.251
AL$82.731
AR$81.741
AZ$88.551
CA$96.22–$119.4129
CO$94.431
CT$95.871
DC$102.751
DE$89.861
FL$88.43–$94.463
GA$84.36–$91.752
GU$98.151
HI$98.151
IA$84.921
ID$85.291
IL$85.97–$93.094
IN$85.711
KS$84.381
KY$83.911
LA$83.71–$87.182
MA$93.92–$103.072
MD$91.45–$102.753
ME$85.43–$89.622
MI$85.53–$89.152
MN$91.521
MO$82.38–$87.703
MS$82.081
MT$90.511
NC$86.221
ND$89.921
NE$85.371
NH$92.801
NJ$97.25–$101.932
NM$85.841
NV$90.411
NY$87.28–$104.455
OH$85.411
OK$84.001
OR$89.98–$97.282
PA$85.64–$93.672
PR$91.151
RI$92.931
SC$85.901
SD$89.851
TN$84.701
TX$85.15–$93.878
UT$86.891
VA$89.22–$102.752
VI$91.151
VT$89.431
WA$93.79–$105.212
WI$87.351
WV$83.251
WY$90.261

See 92012 in every payment locality

How the 92012 rate is calculated

Each of 92012’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 · 92012

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.92

0.92 RVUs× 1.000 GPCI

Practice expense1.76

1.76 RVUs× 1.000 GPCI

Malpractice0.03

0.03 RVUs× 1.000 GPCI

Adjusted RVUs

2.7100

Conversion factor

$33.4009

Medicare rate

$90.52

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

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,661

Code
92012
Physician work
0.92
Practice expense
1.76
Malpractice
0.03

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 92012 in North Carolina
ComponentRVULocality factorAdjusted
Physician work0.92× 1.0000.9200
Practice expense1.76× 0.9331.6421
Malpractice0.03× 0.6390.0192
Total RVUs2.5813
Conversion factor× 33.4009

Office rate, North Carolina$86.22

Office: (0.92 × 1 + 1.76 × 0.933 + 0.03 × 0.639) × $33.4009 = $86.22

Facility: (0.92 × 1 + 0.29 × 0.933 + 0.03 × 0.639) × $33.4009 = $40.41

Open 92012 in the RVU calculator

Payment rules and modifiers for 92012

The CMS indicators that decide how 92012 is paid alongside other services.

CMS payment indicators · 92012

Eye exam, intermediate, established patient

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 92012

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

Codes related to 92012
CodeHow it relatesOffice range, North Carolina
Same family
92002Eye examination, intermediate, new patientIntermediate eye exam for a new patient.$80.93
92014Comprehensive eye exam, established patientComprehensive eye exam for an established patient.$121.52
92004Comprehensive eye exam, new patient, one or more visitsComprehensive eye exam for a new patient.$143.29
Often billed with
92015RefractionRefraction reported separately when performed at the same visit.No office rate
92083Visual field exam, extended visual field testingExtended visual field testing may accompany a glaucoma follow-up exam.$60.42
92134Retinal OCT, posterior segment, retinaRetinal OCT imaging may accompany an exam for macular disease.$31.04
Used instead
99213Office visit, established patient, low complexityOffice E/M visit reported instead of the eye exam code for the same work.$90.84

How 92012 has changed in North Carolina

92012 · Office / nonfacility

$86.22

Effective 2026-10-01

The base rate is $5.20 higher than on 2025-10-01, moving from $81.02 to $86.22 (6.4%).

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

    $81.02changed to$86.22

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.69 changed to 1.76
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $84.31changed to$81.02

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.72 changed to 1.69

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $82.93changed to$84.31

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $85.90changed to$82.93

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.71 changed to 1.72
    • Malpractice RVU 0.04 changed to 0.03
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $86.28changed to$85.90

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.66 changed to 1.71
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $86.67changed to$86.28

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.65 changed to 1.66

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $85.71changed to$86.67

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.54 changed to 1.65
    • Malpractice RVU 0.03 changed to 0.04
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $85.49changed to$85.71

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.53 changed to 1.54
    • Malpractice RVU 0.04 changed to 0.03
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $85.06changed to$85.49

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.52 changed to 1.53

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $82.52changed to$85.06

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.45 changed to 1.52
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $81.99changed to$82.52

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.44 changed to 1.45
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $82.34changed to$81.99

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.45 changed to 1.44
    • Malpractice RVU 0.03 changed to 0.04

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $81.93changed to$82.34

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $82.71changed to$81.93

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.44 changed to 1.45
    • Malpractice RVU 0.07 changed to 0.03
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $82.79changed to$82.71

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.58 changed to 1.44
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $82.79

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$86.22$40.41RVU26D
2026-07-01$86.22$40.41RVU26C
2026-04-01$86.22$40.41RVU26B
2026-01-01$86.22$40.41RVU26A
2025-10-01$81.02$46.28RVU25D
2025-07-01$81.02$46.28RVU25C
2025-04-01$81.02$46.28RVU25B
2025-01-01$81.02$46.28RVU25A
2024-10-01$84.31$47.63RVU24D
2024-07-01$84.31$47.63RVU24C
2024-04-01$84.31$47.63RVU24B
2024-03-09$84.31$47.63RVU24AR
2024-01-01$82.93$46.85RVU24A
2023-10-01$85.90$48.83RVU23D
2023-07-01$85.90$48.83RVU23C
2023-04-01$85.90$48.83RVU23B
2023-01-01$85.90$48.83RVU23A
2022-10-01$86.28$49.67RVU22D
2022-07-01$86.28$49.67RVU22C
2022-04-01$86.28$49.67RVU22B
2022-01-01$86.28$49.67RVU22A
2021-10-01$86.67$50.08RVU21D
2021-07-01$86.67$50.08RVU21C
2021-04-01$86.67$50.08RVU21B
2021-01-01$86.67$50.08RVU21A
2020-10-01$85.71$51.47RVU20D
2020-07-01$85.71$51.47RVU20C
2020-04-01$85.71$51.47RVU20B
2020-01-01$85.71$51.47RVU20A
2019-10-01$85.49$51.94RVU19D
2019-07-01$85.49$51.94RVU19C
2019-04-01$85.49$51.94RVU19B
2019-01-01$85.49$51.94RVU19A
2018-10-01$85.06$52.22RVU18D
2018-07-01$85.06$52.22RVU18C
2018-04-01$85.06$52.22RVU18B
2018-01-01$85.06$52.22RVU18AR1
2017-10-01$82.52$52.11RVU17D
2017-07-01$82.52$52.11RVU17C
2017-04-01$82.52$52.11RVU17B
2017-01-01$82.52$52.11RVU17A
2016-10-01$81.99$51.69RVU16D
2016-07-01$81.99$51.69RVU16C
2016-04-01$81.99$51.69RVU16B
2016-01-01$81.99$51.69RVU16A
2015-10-01$82.34$51.60RVU15D
2015-07-01$82.34$51.60RVU15C
2015-04-01$81.93$51.34RVU15B
2015-01-01$81.93$51.34RVU15A
2014-10-01$82.71$52.76RVU14D
2014-07-01$82.71$52.76RVU14C
2014-04-01$82.71$52.76RVU14B
2014-01-01$82.71$52.76RVU14A
2013-10-01$82.79$50.93RVU13D
2013-07-01$82.79$50.93RVU13C
2013-04-01$82.79$50.93RVU13B
2013-01-01$82.79$50.93RVU13AR

Price 92012 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

92012 billing questions

When should 92014 be reported instead of 92012?

Use 92014 when the documented service is a comprehensive evaluation of the visual system. Use 92012 when the documented examination is intermediate in scope, with diagnostic steps directed by the patient's concern.

Can 92012 be billed with an office E/M code on the same date?

Do not report 92012 and an office E/M code such as 99213 for the same examination and management work. A distinct, separately documented E/M service may be reportable on the same date when its coding requirements are met.

Is refraction included in 92012?

No. Determining refractive error for a lens prescription is reported separately with 92015 when performed.

Should modifier 50 or RT and LT be appended when both eyes are examined?

Do not use modifier 50 to seek additional payment; CMS already prices 92012 as bilateral. RT and LT may identify the examined side when needed, but examining both eyes does not create two units.

Does dilation have to be performed to report 92012?

No. Dilation may be part of an intermediate examination when clinically indicated, but it is not required for this level.

Who counts as an established patient for this code?

A patient who received professional services from the same provider, or another provider of the same specialty in the same group, within the prior three years.

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 92012PPRRVU2026_Oct_nonQPP.csv, line 11,661 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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