CPT code 92014: Comprehensive eye exam, established patient2026 Medicare rate & RVUs in Louisiana
Report a comprehensive ophthalmic evaluation of an established patient when the visual system is assessed and a diagnostic or treatment plan is initiated or continued.
Medicare pays $118.17–$122.81 for 92014 in the office in Louisiana, from Rest of Louisiana to New Orleans, LA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 92014 covers
An ophthalmologist or optometrist performs this comprehensive assessment for an established patient, usually in an eye care office. Established status depends on professional services within the preceding three years from the clinician or a clinician of the same specialty and subspecialty in the same group. The evaluation addresses the visual system through history, general medical observation, external and ophthalmoscopic examinations, gross visual fields, and a basic sensorimotor assessment. Slit-lamp examination, tonometry, or dilation may be included when indicated. Common medical reasons include glaucoma follow-up, cataract evaluation, and diabetic retinopathy monitoring.
Report 92014 once for the comprehensive service, even if completed over multiple visits; use 92012 for an intermediate examination. The record should support the examination scope, medical reason, and initiation or continuation of a diagnostic or treatment plan. Medicare does not cover routine eye exams without a medical indication. Refraction, when performed, is separately reported with 92015 and excluded from Medicare coverage; medically necessary visual field testing or retinal imaging may also be reported separately. The code covers one or both eyes and is already priced 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.
Where 92014 pays more and less in Louisiana
| Payment locality | Office | Facility |
|---|---|---|
| New Orleans, LA | $122.81 | $61.52 |
| Rest of Louisiana | $118.17 | $60.53 |
How the 92014 rate is calculated
Each of 92014’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 · 92014
RVUs × geographic indexes × conversion factor
Work1.42
1.42 RVUs× 1.000 GPCI
Practice expense2.35
2.35 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
3.8100
Conversion factor
$33.4009
Medicare rate
$127.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92014
The CMS indicators that decide how 92014 is paid alongside other services.
CMS payment indicators · 92014
Comprehensive eye exam, established patient
| 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. |
92014 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 92012Eye examIntermediate, established patient
- 92012 covers an intermediate examination of an established patient. Choose 92014 when the documented examination meets the comprehensive scope and initiates or continues a diagnostic or treatment plan.
- 92004Comprehensive eye examNew patient, one or more visits
- Both cover comprehensive eye exams. 92004 is for a new patient; 92014 is for a patient who received professional services from the provider or a same-specialty and subspecialty group member within the preceding three years.
- 92015Refraction
- 92015 reports refraction to determine the eye's refractive state, not a comprehensive ophthalmic examination. Report it separately when performed; Medicare excludes refraction from coverage.
- 99214Office visitEstablished patient, moderate complexity
- 99214 is an office E/M visit selected by medical decision making or time. 92014 is selected by comprehensive ophthalmic examination content. Do not report both for the same examination.
92014 billing questions
When should 92014 be chosen over 92012?
Use 92014 when the documented examination covers the comprehensive visual system assessment and initiates or continues a diagnostic or treatment plan. Use 92012 for an intermediate examination that does not meet that comprehensive scope.
Is refraction included in 92014?
No. Report a separately performed refraction with 92015; Medicare excludes refraction from coverage.
Should modifier RT, LT, or 50 be appended?
Routine reporting of 92014 does not require RT or LT; document the eye or eyes examined. The code covers one or both eyes and is already priced as bilateral, so modifier 50 does not increase payment.
Can an office E/M code be billed instead of 92014?
Yes. An eye care provider may report an office E/M code instead when its documentation requirements are met. Do not report both an office E/M code and 92014 for the same examination.
What qualifies the patient as established for this code?
The patient has received professional services within the preceding three years from the provider or another provider of the same specialty and subspecialty in the same group. If the patient is new, consider 92004 when a comprehensive ophthalmic examination is performed.
Does Medicare pay for an annual comprehensive exam with no complaints?
An annual schedule alone does not establish coverage. A medically indicated examination, such as glaucoma surveillance or diabetic retinal disease monitoring, may qualify even without new complaints; routine vision screening is not covered.
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
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