$126.42
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.
On this page
CMS RVU26D · Effective 2026-10-01
92004 Comprehensive eye exam Medicare reimbursement rates in Delaware
Comprehensive medical eye evaluation for a new patient, with examination of the visual system and initiation of a diagnostic or treatment plan. Compare 92004 office and facility rates across CMS payment localities in Delaware.
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 92004 in Delaware?
Delaware 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
$148.75
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$77.80
1 of 1 localities have a supported rate.
Payment area: Delaware
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 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 Delaware, from the same CMS release.
$84.26
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.
$175.99
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.
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.
Compare 92004 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
Delaware →
Office / nonfacility
$148.75
Facility
$77.80
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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 92004 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
11,660
- Code
- 92004
- Physician work
- 1.82
- Practice expense
- 2.62
- Malpractice
- 0.04
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.82 | × 1.005 | 1.8291 |
| Practice expense | 2.62 | × 0.988 | 2.5886 |
| Malpractice | 0.04 | × 0.899 | 0.0360 |
| Total RVUs | 4.4536 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$148.75
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.82 | 1.005 |
| Practice expense | 2.62 | 0.988 |
| Malpractice | 0.04 | 0.899 |
(1.82 × 1.005 + 2.62 × 0.988 + 0.04 × 0.899) × $33.4009 = $148.75
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.82 | 1.005 |
| Practice expense | 0.47 | 0.988 |
| Malpractice | 0.04 | 0.899 |
(1.82 × 1.005 + 0.47 × 0.988 + 0.04 × 0.899) × $33.4009 = $77.80
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.
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.
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
11,66392015,,Determine refractive state,N,+,0.37,0.18,,0.08,,0.02,0.57,0.47,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503