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CMS RVU26D · Effective 2026-10-01

92004 in Austin

Office / nonfacility

$154.68

Base rate per service

Facility setting

$78.70

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Ophthalmology services

About 92004: Comprehensive eye exam, new patient

Comprehensive medical eye evaluation for a new patient, with examination of the visual system and initiation of a diagnostic or treatment plan.

A comprehensive new-patient eye evaluation includes the patient's history, general medical observation, external and ophthalmoscopic examinations, gross visual fields, and a basic sensorimotor examination. Slit lamp examination, tonometry, and dilation may be performed when indicated. The ophthalmologist or optometrist initiates a diagnostic or treatment plan based on the findings. The service is commonly performed in an office but may also be performed in a facility.

Report 92004 when the patient meets the new-patient definition and the documented service meets the comprehensive examination requirements rather than those for an intermediate examination. A patient is new if no professional service was received from the physician or another physician of the same specialty in the same group during the preceding three years. The evaluation may take one or more visits; report the completed service once. Record the examination findings and plan, and support the medical necessity of the visit. Refraction, when performed, is separately reported. Medicare prices 92004 as bilateral, so modifier 50 does not increase payment.

CMS billing rules for 92004

Bilateral procedures
The code is already priced as bilateral; modifier 50 does not increase payment.

Where the value comes from

  • Work RVU1.82 · 41%
  • Practice expense (office) RVU2.62 · 58%
  • Malpractice RVU0.04 · 1%

1.6M

Medicare services in 2024 · #97 by national volume

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.

92004 compared with similar codes

Office rates for Austin, from the same CMS release.

92014

Comprehensive eye exam

Established patient

$131.75

Both represent comprehensive eye examinations. Use 92004 for a new patient and 92014 for an established patient under the three-year, same-specialty-and-group definition.

92002

Eye examination

Intermediate, new patient

$88.00

92002 is an intermediate new-patient examination. Choose 92004 when the documented examination meets the comprehensive requirements, including ophthalmoscopy and initiation of a diagnostic or treatment plan.

99204

Office visit

New patient, moderate complexity

$181.40

99204 is a new-patient office E/M level selected by medical decision making or qualifying time. Select 92004 by the documented comprehensive ophthalmological service; do not report both codes for the same evaluation.

92018

Eye examination

Comprehensive, under anesthesia

No office rate

92018 describes a comprehensive eye examination performed under general anesthesia. Use 92004 for a qualifying comprehensive new-patient ophthalmological evaluation that is not an examination under general anesthesia.

The same code, a different location

How does Austin compare?

In Beaumont, the office rate for 92004 is $141.67—$13.01 lower than the $154.68 rate in Austin. Both use the same code, release and participation basis.

92004 across payment areas

Same release and payment basis · bars start at $0

  1. Austin · This locality

    $154.68

  2. Beaumont

    $141.67

    $13.01 lower than Austin

  3. Brazoria

    $149.04

    $5.64 lower than Austin

  4. Dallas

    $149.64

    $5.04 lower than Austin

  5. Fort Worth

    $148.79

    $5.89 lower than Austin

  6. Galveston

    $149.28

    $5.40 lower than Austin

  7. Houston

    $150.01

    $4.67 lower than Austin

Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 92004 ranges from $136.65 in Arkansas to $194.38 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Rest Of Texas

    Texas · 92004

    Office

    $145.04

    Facility

    $76.89

    $9.64 lower than Austin for the office setting.

  • Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    California · 92004

    Office

    $167.69

    Facility

    $82.74

    $13.01 higher than Austin for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 92004

    Office

    $168.65

    Facility

    $84.05

    $13.97 higher than Austin for the office setting.

  • Miami

    Florida · 92004

    Office

    $155.27

    Facility

    $80.51

    $0.59 higher than Austin for the office setting.

  • Chicago

    Illinois · 92004

    Office

    $152.23

    Facility

    $80.06

    $2.45 lower than Austin for the office setting.

  • Manhattan

    New York · 92004

    Office

    $168.49

    Facility

    $85.04

    $13.81 higher than Austin for the office setting.

  • Alaska*

    Alaska · 92004

    Office

    $185.12

    Facility

    $108.64

    $30.44 higher than Austin for the office setting.

  • Alabama

    Alabama · 92004

    Office

    $138.12

    Facility

    $75.28

    $16.56 lower than Austin for the office setting.

  • Arkansas

    Arkansas · 92004

    Office

    $136.65

    Facility

    $74.96

    $18.03 lower than Austin for the office setting.

  • Arizona

    Arizona · 92004

    Office

    $146.73

    Facility

    $77.15

    $7.95 lower than Austin for the office setting.

  • Bakersfield

    California · 92004

    Office

    $158.67

    Facility

    $79.96

    $3.99 higher than Austin for the office setting.

  • Chico

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • El Centro

    California · 92004

    Office

    $158.46

    Facility

    $79.75

    $3.78 higher than Austin for the office setting.

  • Fresno

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Hanford-Corcoran

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Madera

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Merced

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Modesto

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Napa

    California · 92004

    Office

    $180.64

    Facility

    $85.99

    $25.96 higher than Austin for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 92004

    Office

    $166.76

    Facility

    $81.88

    $12.08 higher than Austin for the office setting.

  • Redding

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Rest Of California

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 92004

    Office

    $158.93

    Facility

    $80.23

    $4.25 higher than Austin for the office setting.

  • Sacramento-Roseville-Folsom

    California · 92004

    Office

    $165.47

    Facility

    $81.95

    $10.79 higher than Austin for the office setting.

  • Salinas

    California · 92004

    Office

    $164.81

    Facility

    $81.58

    $10.13 higher than Austin for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 92004

    Office

    $168.00

    Facility

    $82.11

    $13.32 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 92004

    Office

    $190.57

    Facility

    $89.31

    $35.89 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 92004

    Office

    $190.52

    Facility

    $89.27

    $35.84 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 92004

    Office

    $194.38

    Facility

    $90.83

    $39.70 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 92004

    Office

    $194.20

    Facility

    $90.64

    $39.52 higher than Austin for the office setting.

  • San Luis Obispo-Paso Robles

    California · 92004

    Office

    $162.21

    Facility

    $80.42

    $7.53 higher than Austin for the office setting.

  • Santa Cruz-Watsonville

    California · 92004

    Office

    $169.11

    Facility

    $81.86

    $14.43 higher than Austin for the office setting.

  • Santa Maria-Santa Barbara

    California · 92004

    Office

    $165.24

    Facility

    $81.51

    $10.56 higher than Austin for the office setting.

  • Santa Rosa-Petaluma

    California · 92004

    Office

    $170.79

    Facility

    $82.61

    $16.11 higher than Austin for the office setting.

  • Stockton

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Vallejo

    California · 92004

    Office

    $180.57

    Facility

    $85.92

    $25.89 higher than Austin for the office setting.

  • Visalia

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Yuba City

    California · 92004

    Office

    $158.45

    Facility

    $79.74

    $3.77 higher than Austin for the office setting.

  • Colorado

    Colorado · 92004

    Office

    $155.67

    Facility

    $79.27

    $0.99 higher than Austin for the office setting.

  • Connecticut

    Connecticut · 92004

    Office

    $157.87

    Facility

    $80.53

    $3.19 higher than Austin for the office setting.

  • Delaware

    Delaware · 92004

    Office

    $148.75

    Facility

    $77.80

    $5.93 lower than Austin for the office setting.

  • Fort Lauderdale

    Florida · 92004

    Office

    $151.85

    Facility

    $79.11

    $2.83 lower than Austin for the office setting.

  • Rest Of Florida

    Florida · 92004

    Office

    $146.46

    Facility

    $77.81

    $8.22 lower than Austin for the office setting.

  • Atlanta

    Georgia · 92004

    Office

    $151.49

    Facility

    $78.53

    $3.19 lower than Austin for the office setting.

  • Rest Of Georgia

    Georgia · 92004

    Office

    $140.44

    Facility

    $76.39

    $14.24 lower than Austin for the office setting.

  • Hawaii, Guam

    Hawaii · 92004

    Office

    $161.06

    Facility

    $79.41

    $6.38 higher than Austin for the office setting.

  • Iowa

    Iowa · 92004

    Office

    $141.39

    Facility

    $75.68

    $13.29 lower than Austin for the office setting.

  • Idaho

    Idaho · 92004

    Office

    $141.93

    Facility

    $75.86

    $12.75 lower than Austin for the office setting.

  • East St. Louis

    Illinois · 92004

    Office

    $143.99

    Facility

    $77.92

    $10.69 lower than Austin for the office setting.

  • Rest Of Illinois

    Illinois · 92004

    Office

    $142.77

    Facility

    $77.21

    $11.91 lower than Austin for the office setting.

  • Suburban Chicago

    Illinois · 92004

    Office

    $153.46

    Facility

    $79.70

    $1.22 lower than Austin for the office setting.

  • Indiana

    Indiana · 92004

    Office

    $142.56

    Facility

    $75.99

    $12.12 lower than Austin for the office setting.

  • Kansas

    Kansas · 92004

    Office

    $140.57

    Facility

    $75.65

    $14.11 lower than Austin for the office setting.

  • Kentucky

    Kentucky · 92004

    Office

    $139.81

    Facility

    $75.97

    $14.87 lower than Austin for the office setting.

  • New Orleans

    Louisiana · 92004

    Office

    $144.65

    Facility

    $77.08

    $10.03 lower than Austin for the office setting.

  • Rest Of Louisiana

    Louisiana · 92004

    Office

    $139.52

    Facility

    $75.96

    $15.16 lower than Austin for the office setting.

  • Metropolitan Boston

    Massachusetts · 92004

    Office

    $168.96

    Facility

    $83.22

    $14.28 higher than Austin for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 92004

    Office

    $154.98

    Facility

    $79.36

    $0.30 higher than Austin for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 92004

    Office

    $157.31

    Facility

    $80.26

    $2.63 higher than Austin for the office setting.

  • Rest Of Maryland

    Maryland · 92004

    Office

    $151.18

    Facility

    $78.51

    $3.50 lower than Austin for the office setting.

  • Rest Of Maine

    Maine · 92004

    Office

    $142.13

    Facility

    $76.06

    $12.55 lower than Austin for the office setting.

  • Southern Maine

    Maine · 92004

    Office

    $148.36

    Facility

    $77.19

    $6.32 lower than Austin for the office setting.

  • Detroit

    Michigan · 92004

    Office

    $147.49

    Facility

    $78.19

    $7.19 lower than Austin for the office setting.

  • Rest Of Michigan

    Michigan · 92004

    Office

    $142.19

    Facility

    $76.63

    $12.49 lower than Austin for the office setting.

  • Minnesota

    Minnesota · 92004

    Office

    $151.23

    Facility

    $77.34

    $3.45 lower than Austin for the office setting.

  • Metropolitan Kansas City

    Missouri · 92004

    Office

    $144.27

    Facility

    $76.84

    $10.41 lower than Austin for the office setting.

  • Metropolitan St. Louis

    Missouri · 92004

    Office

    $145.44

    Facility

    $77.07

    $9.24 lower than Austin for the office setting.

  • Rest Of Missouri

    Missouri · 92004

    Office

    $137.52

    Facility

    $75.62

    $17.16 lower than Austin for the office setting.

  • Mississippi

    Mississippi · 92004

    Office

    $137.12

    Facility

    $75.29

    $17.56 lower than Austin for the office setting.

  • Montana**

    Montana · 92004

    Office

    $149.63

    Facility

    $77.82

    $5.05 lower than Austin for the office setting.

  • North Carolina

    North Carolina · 92004

    Office

    $143.29

    Facility

    $76.29

    $11.39 lower than Austin for the office setting.

  • North Dakota**

    North Dakota · 92004

    Office

    $148.84

    Facility

    $77.03

    $5.84 lower than Austin for the office setting.

  • Nebraska

    Nebraska · 92004

    Office

    $142.07

    Facility

    $75.78

    $12.61 lower than Austin for the office setting.

  • New Hampshire

    New Hampshire · 92004

    Office

    $153.06

    Facility

    $78.30

    $1.62 lower than Austin for the office setting.

  • Northern Nj

    New Jersey · 92004

    Office

    $167.56

    Facility

    $84.26

    $12.88 higher than Austin for the office setting.

  • Rest Of New Jersey

    New Jersey · 92004

    Office

    $160.25

    Facility

    $81.83

    $5.57 higher than Austin for the office setting.

  • New Mexico

    New Mexico · 92004

    Office

    $142.64

    Facility

    $76.79

    $12.04 lower than Austin for the office setting.

  • Nevada**

    Nevada · 92004

    Office

    $149.50

    Facility

    $77.62

    $5.18 lower than Austin for the office setting.

  • Nyc Suburbs/Long Island

    New York · 92004

    Office

    $171.21

    Facility

    $85.83

    $16.53 higher than Austin for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 92004

    Office

    $160.97

    Facility

    $82.33

    $6.29 higher than Austin for the office setting.

  • Queens

    New York · 92004

    Office

    $170.04

    Facility

    $85.16

    $15.36 higher than Austin for the office setting.

  • Rest Of New York

    New York · 92004

    Office

    $144.86

    Facility

    $76.64

    $9.82 lower than Austin for the office setting.

  • Ohio

    Ohio · 92004

    Office

    $142.03

    Facility

    $76.47

    $12.65 lower than Austin for the office setting.

  • Oklahoma

    Oklahoma · 92004

    Office

    $139.97

    Facility

    $75.85

    $14.71 lower than Austin for the office setting.

  • Portland

    Oregon · 92004

    Office

    $159.98

    Facility

    $80.20

    $5.30 higher than Austin for the office setting.

  • Rest Of Oregon

    Oregon · 92004

    Office

    $148.89

    Facility

    $77.36

    $5.79 lower than Austin for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 92004

    Office

    $154.58

    Facility

    $79.82

    $0.10 lower than Austin for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 92004

    Office

    $142.39

    Facility

    $76.46

    $12.29 lower than Austin for the office setting.

  • Puerto Rico

    Puerto Rico · 92004

    Office

    $150.58

    Facility

    $77.98

    $4.10 lower than Austin for the office setting.

  • Rhode Island

    Rhode Island · 92004

    Office

    $153.53

    Facility

    $79.35

    $1.15 lower than Austin for the office setting.

  • South Carolina

    South Carolina · 92004

    Office

    $142.78

    Facility

    $76.43

    $11.90 lower than Austin for the office setting.

  • South Dakota**

    South Dakota · 92004

    Office

    $148.75

    Facility

    $76.94

    $5.93 lower than Austin for the office setting.

  • Tennessee

    Tennessee · 92004

    Office

    $141.05

    Facility

    $75.78

    $13.63 lower than Austin for the office setting.

  • Utah

    Utah · 92004

    Office

    $144.25

    Facility

    $76.75

    $10.43 lower than Austin for the office setting.

  • Virginia

    Virginia · 92004

    Office

    $147.76

    Facility

    $77.16

    $6.92 lower than Austin for the office setting.

  • Virgin Islands

    United States Virgin Islands · 92004

    Office

    $150.58

    Facility

    $77.98

    $4.10 lower than Austin for the office setting.

  • Vermont

    Vermont · 92004

    Office

    $148.10

    Facility

    $77.01

    $6.58 lower than Austin for the office setting.

  • Rest Of Washington

    Washington · 92004

    Office

    $154.75

    Facility

    $79.13

    $0.07 higher than Austin for the office setting.

  • Seattle (King Cnty)

    Washington · 92004

    Office

    $172.30

    Facility

    $84.18

    $17.62 higher than Austin for the office setting.

  • Wisconsin

    Wisconsin · 92004

    Office

    $145.04

    Facility

    $76.24

    $9.64 lower than Austin for the office setting.

  • West Virginia

    West Virginia · 92004

    Office

    $138.75

    Facility

    $76.34

    $15.93 lower than Austin for the office setting.

  • Wyoming**

    Wyoming · 92004

    Office

    $149.29

    Facility

    $77.48

    $5.39 lower than Austin for the office setting.

See how rates vary across the country

92004 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$136.65

$185.12

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$185.121
AL$138.121
AR$136.651
AZ$146.731
CA$158.45–$194.3829
CO$155.671
CT$157.871
DC$168.651
DE$148.751
FL$146.46–$155.273
GA$140.44–$151.492
GU$161.061
HI$161.061
IA$141.391
ID$141.931
IL$142.77–$153.464
IN$142.561
KS$140.571
KY$139.811
LA$139.52–$144.652
MA$154.98–$168.962
MD$151.18–$168.653
ME$142.13–$148.362
MI$142.19–$147.492
MN$151.231
MO$137.52–$145.443
MS$137.121
MT$149.631
NC$143.291
ND$148.841
NE$142.071
NH$153.061
NJ$160.25–$167.562
NM$142.641
NV$149.501
NY$144.86–$171.215
OH$142.031
OK$139.971
OR$148.89–$159.982
PA$142.39–$154.582
PR$150.581
RI$153.531
SC$142.781
SD$148.751
TN$141.051
TX$141.67–$154.688
UT$144.251
VA$147.76–$168.652
VI$150.581
VT$148.101
WA$154.75–$172.302
WI$145.041
WV$138.751
WY$149.291

Explore 92004 on the national rate map →

Where does this rate apply?

Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Texas →

Why are the office and facility amounts different?

For 92004 in Austin, the physician’s office rate is $154.68 and the facility-setting rate is $78.70: a difference of $75.98.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 92004 in Austin. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$170.15

$154.68 × 110% = $170.15

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 92004 in Austin.

PPRRVU2026_Oct_nonQPP.csv

11,660

Code
92004
Physician work
1.82
Practice expense
2.62
Malpractice
0.04

GPCI2026.csv

96

Locality
Austin
Physician work
1.002
Practice expense
1.058
Malpractice
0.886
Office / nonfacility calculation for 92004 in Austin
ComponentRVULocality factorAdjusted
Physician work1.82× 1.0021.8236
Practice expense2.62× 1.0582.7720
Malpractice0.04× 0.8860.0354
Total RVUs4.6310
Conversion factor× 33.4009

Office / nonfacility rate, Austin$154.68

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 92004 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.821.002
Practice expense2.621.058
Malpractice0.040.886

(1.82 × 1.002 + 2.62 × 1.058 + 0.04 × 0.886) × $33.4009 = $154.68

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.821.002
Practice expense0.471.058
Malpractice0.040.886

(1.82 × 1.002 + 0.47 × 1.058 + 0.04 × 0.886) × $33.4009 = $78.70

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

92004 · Office / nonfacility

$154.68

Effective 2026-10-01

The base rate is $8.01 higher than on 2025-10-01, moving from $146.67 to $154.68 (5.5%).

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

    $146.67changed to$154.68

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 2.56 changed to 2.62
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 1.046 changed to 1.058
    • Malpractice GPCI 0.914 changed to 0.886

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $146.67

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$154.68$78.70RVU26D
2026-07-01$154.68$78.70RVU26C
2026-04-01$154.68$78.70RVU26B
2026-01-01$154.68$78.70RVU26A
2025-10-01$146.67$90.50RVU25D
2025-07-01$146.67$90.50RVU25C
2025-04-01$146.67$90.50RVU25B
2025-01-01$146.67$90.50RVU25A

92004 billing questions

When should 92004 be chosen over 92002?

Choose 92004 when the documented new-patient service meets the comprehensive examination requirements, including ophthalmoscopy and initiation of a diagnostic or treatment plan. Choose 92002 for an intermediate new-patient examination.

Is refraction included in 92004?

No. When performed and documented, determination of refractive state is reported separately with 92015. Medicare generally excludes refraction from coverage.

Should modifier 50 or RT/LT be appended?

Do not append modifier 50 to seek bilateral payment: 92004 is already priced as bilateral. An RT or LT modifier does not create a second payable eye examination.

Can 92004 and a new-patient E/M code be billed on the same day?

Do not report both for the same evaluation by the same provider. Select the code that describes the documented encounter; a genuinely separate E/M service requires its own supporting documentation and must meet applicable billing rules.

What if the comprehensive exam takes two visits?

The comprehensive service may span more than one visit, such as when a patient returns to complete the examination. Report 92004 once when the service is complete.

Are dilation and tonometry billed separately?

No. Dilation and tonometry performed as part of the comprehensive examination are not separately reported. A distinct diagnostic test, such as medically necessary visual field testing, may be reported separately when performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 92004PPRRVU2026_Oct_nonQPP.csv, line 11,660 (RVU26D)
Geographic factors for AustinGPCI2026.csv, line 96 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet