$124.48–$132.52
92014 covers a comprehensive evaluation of the visual system; 92012 covers an intermediate examination with diagnostic steps indicated by the patient's concern. Select the code supported by the documented scope.
On this page
CMS RVU26D · Effective 2026-10-01
92012 Eye exam Medicare reimbursement rates in Florida
An intermediate ophthalmological exam is reported when an ophthalmologist or optometrist evaluates a defined eye concern in an established patient without performing a comprehensive exam. Compare 92012 office and facility rates across CMS payment localities in Florida.
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 92012 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$88.43–$94.46
3 of 3 localities have a supported rate.
Facility setting
$41.49–$43.35
3 of 3 localities have a supported rate.
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.
Where 92012 pays more and less in Florida
3 payment localities
$88.43 to $94.46
Ophthalmology services
About 92012: Intermediate eye exam, established patient
An intermediate ophthalmological exam is reported when an ophthalmologist or optometrist evaluates a defined eye concern in an established patient without performing a comprehensive exam.
An intermediate ophthalmological examination addresses a defined eye concern or interval reassessment in a returning patient. The ophthalmologist or optometrist obtains an interval history, makes general medical observations, examines the external eye and surrounding structures, and performs other diagnostic steps as indicated. The examination may involve one eye or both and may include dilation when needed. The clinician establishes or updates a diagnostic and treatment plan based on the findings. This service is commonly furnished in an office or outpatient eye clinic.
Report 92012 when the patient qualifies as established and the documented examination supports an intermediate rather than comprehensive ophthalmological service. Record the presenting concern, pertinent history, examined structures, findings, and diagnostic and treatment plan. A comprehensive evaluation of the visual system is reported with 92014 instead. Refraction, if performed, is reported separately with 92015. Medically necessary visual field or retinal imaging tests require separate documentation to support reporting them alongside the exam. CMS prices 92012 as bilateral, so examining both eyes does not support two units, and modifier 50 does not increase payment.
CMS billing rules for 92012
- Bilateral procedures
- The code is already priced as bilateral; modifier 50 does not increase payment.
Where the value comes from
- Work RVU0.92 · 34%
- Practice expense (office) RVU1.76 · 65%
- Malpractice RVU0.03 · 1%
3.2M
Medicare services in 2024 · #58 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.
92012 compared with similar codes
Office rates for Florida, from the same CMS release.
$82.76–$88.11
92002 is the intermediate exam for a new patient; 92012 is for a patient who meets the established-patient definition.
$94.56–$101.79
99213 is an office E/M level selected by medical decision making or qualifying total time; 92012 is an intermediate ophthalmological exam. Do not report both for the same work.
92015
No office rateDetermine refractive state
92015 describes refraction to determine a lens prescription. Report it separately from 92012 when refraction is performed.
Compare 92012 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.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
$92.09
Facility
$42.35
Miami →
Office / nonfacility
$94.46
Facility
$43.35
Rest Of Florida →
Office / nonfacility
$88.43
Facility
$41.49
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92012 billing questions
When should 92014 be reported instead of 92012?
Use 92014 when the documented service is a comprehensive evaluation of the visual system. Use 92012 when the documented examination is intermediate in scope, with diagnostic steps directed by the patient's concern.
Can 92012 be billed with an office E/M code on the same date?
Do not report 92012 and an office E/M code such as 99213 for the same examination and management work. A distinct, separately documented E/M service may be reportable on the same date when its coding requirements are met.
Is refraction included in 92012?
No. Determining refractive error for a lens prescription is reported separately with 92015 when performed.
Should modifier 50 or RT and LT be appended when both eyes are examined?
Do not use modifier 50 to seek additional payment; CMS already prices 92012 as bilateral. RT and LT may identify the examined side when needed, but examining both eyes does not create two units.
Does dilation have to be performed to report 92012?
No. Dilation may be part of an intermediate examination when clinically indicated, but it is not required for this level.
Who counts as an established patient for this code?
A patient who received professional services from the same provider, or another provider of the same specialty in the same group, within the prior three years.
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.
11,65891323,,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
11,66492018,,Compl oph exam general anes,A,,2.44,0.84,NA,0.84,,0.11,3.39,3.39,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00