CPT code 92065: Orthoptic training, direct patient contact2026 Medicare rate & RVUs in Illinois
Report 92065 for a directly delivered orthoptic or pleoptic training session with continuing medical direction and evaluation, such as therapy for binocular vision dysfunction.
Medicare pays $37.29–$39.24 for 92065 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. 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.
Your location
On this page 9 sections
What 92065 covers
This service covers a hands-on session of orthoptic or pleoptic training delivered in direct contact with the patient. Ophthalmologists, optometrists, or other qualified health care professionals may perform sessions that address visual function, such as binocular coordination or convergence problems. Training may use prescribed eye exercises or other structured activities selected for the patient’s diagnosed condition and treatment goals; it is not simply an eye examination or a recommendation for home exercises.
Report the code for each qualifying session, supported by documentation of the condition treated, the training performed, the patient’s participation and response, and the continuing medical direction and evaluation. The record should distinguish the treatment session from a separately performed assessment, such as a sensorimotor examination. CMS pricing treats this code 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 92065 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$37.29 to $39.24
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $39.08 | $28.00 |
| East St. Louis, IL | $37.55 | $27.41 |
| Rest of Illinois | $37.29 | $27.23 |
| Suburban Chicago, IL | $39.24 | $27.92 |
How the 92065 rate is calculated
Each of 92065’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 · 92065
RVUs × geographic indexes × conversion factor
Work0.69
0.69 RVUs× 1.000 GPCI
Practice expense0.45
0.45 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
1.1500
Conversion factor
$33.4009
Medicare rate
$38.41
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92065
The CMS indicators that decide how 92065 is paid alongside other services.
CMS payment indicators · 92065
Orthoptic training, direct patient contact
| 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. |
92065 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92066Orthoptic trainingSupervised service
- Choose 92065 for training performed in direct patient contact by a physician or other qualified health care professional. Use 92066 for training performed under that professional’s supervision.
- 92060Eye alignment testMultiple deviation measurements
- 92060 is a diagnostic sensorimotor examination of ocular alignment and movement; 92065 is a therapeutic training session.
- 92014Comprehensive eye examEstablished patient
- 92014 reports a comprehensive ophthalmological examination for an established patient. It does not describe a therapeutic orthoptic or pleoptic training session.
92065 billing questions
How does 92065 differ from 92066?
92065 is for training delivered in direct contact with the patient by a physician or other qualified health care professional. 92066 describes training performed under a physician’s or qualified health care professional’s supervision.
Can 92065 be reported with a sensorimotor examination?
Yes, when a distinct sensorimotor examination is performed and documented in addition to the training session. The examination evaluates alignment or eye movement; the training is the therapeutic service.
Should modifier 50 be appended?
No. CMS pricing already treats 92065 as bilateral, and modifier 50 does not increase payment.
What documentation supports a session?
Document the treated visual condition, the specific training activities, direct patient participation, the response or progress, and the continuing medical direction and evaluation.
Is 92065 reported per hour or per exercise?
The code is reported for each qualifying training session, not separately for each exercise. The record should identify the session and the services delivered.
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 · Coming soon
Put 92065 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist