CPT code 92201: Extended ophthalmoscopy, retinal drawing2026 Medicare rate & RVUs in Massachusetts
Report 92201 for an extended examination of the retina with a documented drawing, interpretation, and report, for one or both eyes.
Medicare pays $25.73–$27.71 for 92201 in the office in Massachusetts, from Rest of Massachusetts to Metropolitan Boston, MA. 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 92201 covers
An ophthalmologist or other qualified eye-care professional performs an extended examination of the retina and records the findings in a retinal drawing. Typical reasons include evaluating or documenting retinal detachment or a retinal melanoma. The service involves more than routine ophthalmoscopy: the record should show the retinal findings examined and include the drawing and the clinician’s interpretation and report.
Select 92201 when the documented drawing concerns the retina; use the related code 92202 when the drawing concerns the optic nerve or macula. The code covers unilateral or bilateral service. CMS prices it as bilateral, so modifier 50 does not increase payment. Documentation should identify the eye or eyes examined, the clinical findings, and the drawing and report supporting the extended examination.
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 92201 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | $27.71 | $19.74 |
| Rest of Massachusetts | $25.73 | $18.69 |
How the 92201 rate is calculated
Each of 92201’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 · 92201
RVUs × geographic indexes × conversion factor
Work0.39
0.39 RVUs× 1.000 GPCI
Practice expense0.34
0.34 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
0.7500
Conversion factor
$33.4009
Medicare rate
$25.05
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92201
The CMS indicators that decide how 92201 is paid alongside other services.
CMS payment indicators · 92201
Extended ophthalmoscopy, retinal drawing
| 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. |
92201 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92202Extended ophthalmoscopyOptic nerve or macula drawing
- Choose 92201 for a retinal drawing; choose 92202 when the documented drawing focuses on the optic nerve or macula.
- 92250Fundus photographyRetinal photos with interpretation
- 92201 involves an extended ophthalmoscopic examination with a drawing and report. 92250 describes fundus photography with interpretation and report.
- 92228Retinal imagingPhysician or QHP interpretation
- 92228 describes retinal imaging for disease detection or monitoring by a physician or qualified health professional, not an extended ophthalmoscopic examination with a drawing.
92201 billing questions
How is 92201 different from 92202?
92201 is for an extended examination with a retinal drawing. 92202 is for a drawing of the optic nerve or macula.
Can 92201 be reported for both eyes?
Yes. The code covers unilateral or bilateral service, and CMS prices it as bilateral. Modifier 50 does not increase payment.
What documentation supports 92201?
Document the eye or eyes examined, the retinal findings, and the drawing, interpretation, and report. A routine eye examination without the retinal drawing and report does not describe this service.
Is a retinal photograph the same service as 92201?
No. 92201 describes an extended ophthalmoscopic examination with a retinal drawing and report. Fundus photography, reported with 92250, records the retina photographically.
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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