CPT code 92265: Ocular muscle EMG, needle study, one or more muscles2026 Medicare rate & RVUs in Illinois
Needle oculoelectromyography records electrical activity in one or more extraocular muscles to investigate suspected muscle or nerve-related eye movement problems.
Medicare pays $83.24–$90.53 for 92265 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.
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On this page 9 sections
What 92265 covers
An ophthalmologist or other qualified eye-care professional inserts a needle electrode into one or more extraocular muscles and records their electrical activity. The test can help evaluate selected cases of strabismus, diplopia, or suspected extraocular muscle or nerve dysfunction. It is a targeted muscle study, not a retinal test or a photograph of eye movement.
Report the service when needle recording and interpretation of extraocular muscle activity are performed; document the clinical question, muscles tested, findings, and interpretation. The code covers one or more muscles and is priced as bilateral, so modifier 50 does not increase payment. The test has professional and technical components: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and no component modifier reports the global service. The ophthalmology diagnostic multiple procedure reduction applies to the technical component.
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 92265 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
$83.24 to $90.53
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $89.53 | Unavailable |
| East St. Louis, IL | $83.97 | Unavailable |
| Rest of Illinois | $83.24 | Unavailable |
| Suburban Chicago, IL | $90.53 | Unavailable |
How the 92265 rate is calculated
Each of 92265’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 · 92265
RVUs × geographic indexes × conversion factor
Work0.79
0.79 RVUs× 1.000 GPCI
Practice expense1.83
1.83 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
2.6400
Conversion factor
$33.4009
Medicare rate
$88.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92265
The CMS indicators that decide how 92265 is paid alongside other services.
CMS payment indicators · 92265
Ocular muscle EMG, needle study, one or more muscles
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 7 | Diagnostic ophthalmology reduction applies to the technical component. |
| 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 | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
92265 without 26 · national office
$88.18
Ocular muscle EMG, needle study, one or more muscles
92265-26 · Professional component
$45.09
Pays only the interpretation and report.
92265 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92270Electro-oculographyWith interpretation and report
- Choose 92265 for needle recording of extraocular muscle activity. Code 92270 is electro-oculography, a different electrical test rather than a needle muscle study.
- 92273Full-field ERGWith interpretation and report
- Code 92273 evaluates retinal electrical responses with full-field electroretinography; 92265 evaluates electrical activity in extraocular muscles.
- 92060Eye alignment testMultiple deviation measurements
- Code 92060 reports sensorimotor measurements of ocular alignment and movement. It does not represent needle recording of extraocular muscle activity.
92265 billing questions
Does the code count each extraocular muscle separately?
The service covers one or more extraocular muscles, rather than assigning a separate code for each muscle. Document the muscles tested and the findings.
Should modifier 50 be used when both eyes are evaluated?
No. CMS prices this code as bilateral, and modifier 50 does not increase payment.
When should modifier 26 or TC be reported?
Use modifier 26 for the professional interpretation or TC for the technical service involving equipment and staff. Without either modifier, the code represents the global service.
Does the multiple procedure reduction affect the entire service?
The ophthalmology diagnostic multiple procedure reduction applies to the technical component. It does not apply to the professional component.
How is this different from electro-oculography?
Needle oculoelectromyography records electrical activity in extraocular muscles. Electro-oculography records eye-related electrical potential and is not a needle muscle study.
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.
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