Billing code 92012: Eye examMedicare rate & RVUs in Oklahoma
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.
Medicare pays $84.00 for 92012 in the office in Oklahoma (Oklahoma). 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.
On this page 9 sections
What 92012 covers
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.
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 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | $84.00 | $40.16 |
How the 92012 rate is calculated
Each of 92012’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 · 92012
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.92Practice expense 1.76Malpractice 0.03
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 92012
The CMS indicators that decide how 92012 is paid alongside other services.
CMS payment indicators · 92012
Eye exam
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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 | 0 | Physician service: no professional/technical split. |
92012 compared with similar codes
Compare codes
92012 vs 92014 vs 92002 vs 99213 vs 92015: national Medicare rates
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How to choose
- 92014Comprehensive eye exam
- 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.
- 92002Eye examination
- 92002 is the intermediate exam for a new patient; 92012 is for a patient who meets the established-patient definition.
- 99213Office visit
- 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.
- 92015Determine refractive state
- 92015 describes refraction to determine a lens prescription. Report it separately from 92012 when refraction is performed.
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 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.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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