$138.12
Both are for new patients, but 92004 represents a comprehensive eye examination; 92002 represents an intermediate examination.
On this page
CMS RVU26D · Effective 2026-10-01
92002 Eye examination Medicare reimbursement rates in Alabama
An ophthalmologist or optometrist reports this intermediate examination for a new patient when evaluating an eye concern and beginning a diagnostic or treatment plan. Compare 92002 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 92002 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$77.70
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$36.49
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmology
About 92002: Intermediate new-patient eye examination
An ophthalmologist or optometrist reports this intermediate examination for a new patient when evaluating an eye concern and beginning a diagnostic or treatment plan.
This service is an intermediate ophthalmological evaluation for a new patient, commonly performed by an ophthalmologist or optometrist in an office or outpatient setting. The clinician evaluates the patient’s eye complaint or finding, examines relevant ocular structures, and uses diagnostic procedures as indicated to decide on an initial diagnostic or treatment approach. Examples of reasons for evaluation include new blurred vision, eye discomfort, or a newly observed ocular finding.
Select 92002 when the documented service is intermediate rather than a comprehensive eye examination and the patient meets the new-patient criteria for the reporting clinician and group. The record should support the eye-related history, examination performed, relevant findings, and the diagnostic or treatment plan initiated. The code is priced as bilateral; reporting modifier 50 does not increase payment. Report a separate diagnostic service only when it was performed and is independently reportable.
CMS billing rules for 92002
- Bilateral procedures
- The code is already priced as bilateral; modifier 50 does not increase payment.
Where the value comes from
- Work RVU0.88 · 35%
- Practice expense (office) RVU1.64 · 65%
- Malpractice RVU0.02 · 1%
113.4K
Medicare services in 2024 · #523 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.
92002 compared with similar codes
Office rates for Alabama, from the same CMS release.
$82.73
Both describe an intermediate ophthalmological examination. Use 92002 for a new patient and 92012 for an established patient.
$116.87
92014 is the comprehensive examination for an established patient. 92002 is intermediate and applies to a new patient.
Compare 92002 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$77.70
Facility
$36.49
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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 92002 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
11,659
- Code
- 92002
- Physician work
- 0.88
- Practice expense
- 1.64
- Malpractice
- 0.02
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.88 | × 1.000 | 0.8800 |
| Practice expense | 1.64 | × 0.875 | 1.4350 |
| Malpractice | 0.02 | × 0.566 | 0.0113 |
| Total RVUs | 2.3263 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$77.70
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.88 | 1 |
| Practice expense | 1.64 | 0.875 |
| Malpractice | 0.02 | 0.566 |
(0.88 × 1 + 1.64 × 0.875 + 0.02 × 0.566) × $33.4009 = $77.70
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.88 | 1 |
| Practice expense | 0.23 | 0.875 |
| Malpractice | 0.02 | 0.566 |
(0.88 × 1 + 0.23 × 0.875 + 0.02 × 0.566) × $33.4009 = $36.49
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.
92002 billing questions
When should 92002 be chosen over 92004?
Use 92002 for an intermediate new-patient ophthalmological evaluation. Choose 92004 when the service meets the level of a comprehensive new-patient eye examination.
Can 92002 be reported for an established patient?
No. The intermediate eye-examination code for an established patient is 92012. Apply the new-patient criteria to the reporting clinician and group.
Should modifier 50 be appended when both eyes are examined?
No. CMS prices 92002 as bilateral, and modifier 50 does not increase its payment.
Is a refraction included in 92002?
A refraction is a distinct service reported with 92015 when performed and separately reportable. Document the refraction separately from the evaluation supporting 92002.
What documentation supports 92002?
Document the eye-related history, examination and findings, diagnostic procedures performed as indicated, and the diagnostic or treatment plan initiated. The record should support an intermediate—not comprehensive—level of examination.
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.
11,65691321,,Sarscov2 vac 25 mcg/.25ml im,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
11,65791322,,Sarscov2 vac 50 mcg/0.5ml im,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
11,65891323,,Sarscov2 vac 10 mcg/0.2ml im,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
11,65992002,,Intrm oph exam new patient,A,,0.88,1.64,,0.23,,0.02,2.54,1.13,0,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,66092004,,Compre oph exam new pt 1/>,A,,1.82,2.62,,0.47,,0.04,4.48,2.33,0,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,66192012,,Intrm oph exam est patient,A,,0.92,1.76,,0.29,,0.03,2.71,1.24,0,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,66292014,,Compre oph exam est pt 1/>,A,,1.42,2.35,,0.40,,0.04,3.81,1.86,0,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515