No office rate
Both describe an ophthalmic examination under general anesthesia. Choose 92018 for comprehensive work and 92019 for a limited examination.
On this page
CMS RVU26D · Effective 2026-10-01
92018 Eye examination Medicare reimbursement rates in Pennsylvania
A comprehensive ophthalmic assessment performed under general anesthesia when a complete, reliable examination cannot be obtained while the patient is awake. Compare 92018 office and facility rates across CMS payment localities in Pennsylvania.
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 92018 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$110.73–$116.56
2 of 2 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.
Ophthalmology
About 92018: Comprehensive eye examination under anesthesia
A comprehensive ophthalmic assessment performed under general anesthesia when a complete, reliable examination cannot be obtained while the patient is awake.
An ophthalmologist performs a full diagnostic eye assessment while the patient is under general anesthesia, allowing evaluation when a reliable examination cannot be completed awake. Common situations include a young child or a patient with significant developmental, behavioral, or physical limitations. The examination may take place in an operating room or another anesthesia-capable setting, and may include manipulation of the globe when needed for diagnostic or therapeutic purposes. This service is broader than a limited anesthetized eye examination.
Select 92018 when the documented ophthalmic work is comprehensive rather than a targeted check of one problem. Record why anesthesia was needed, which examination elements were completed, the findings, and any manipulation or treatment performed. The anesthesia setting alone does not establish the comprehensive level; the scope of the eye examination does. Document the service as a comprehensive assessment rather than splitting its routine examination observations among separate eye-exam codes. A limited examination under anesthesia is reported with 92019.
Where the value comes from
- Work RVU2.44 · 72%
- Practice expense (office) RVU0.84 · 25%
- Malpractice RVU0.11 · 3%
741
Medicare services in 2024 · #3215 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.
92018 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$142.39–$154.58
92004 is a comprehensive eye examination for a new patient who can be examined without general anesthesia; 92018 is selected for a comprehensive assessment performed under anesthesia.
$120.75–$131.59
92014 is the comprehensive eye examination for an established patient examined without general anesthesia. 92018 is distinguished by the comprehensive examination under anesthesia.
Compare 92018 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$116.56
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$110.73
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92018 billing questions
When should 92018 be chosen over 92019?
Use 92018 for a comprehensive ophthalmic assessment under anesthesia. Use 92019 when the anesthetized examination is limited in scope.
Does the patient have to be a child?
No. The relevant circumstance is the need for general anesthesia to obtain the documented examination, not the patient's age.
Does 92018 include the anesthesia service?
No. 92018 represents the ophthalmologist's examination; the anesthesia professional's service is separate.
Does general anesthesia itself require a modifier?
General anesthesia alone is not a reason to append a modifier to 92018.
What documentation supports reporting 92018?
Document why an examination while awake was not feasible, the scope of the comprehensive eye assessment, the findings, and any globe manipulation or treatment 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.
11,66192012,,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
11,66592019,,Lmtd oph exam general anes,A,,1.28,0.42,NA,0.42,,0.06,1.76,1.76,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,66692020,,Gonioscopy,A,,0.36,0.43,,0.12,,0.01,0.80,0.49,0,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,66792025,,Cptrized corneal topography,A,,0.34,0.75,,0.75,NA,0.02,1.11,1.11,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00