Billing code 92250: Fundus photographyMedicare rate & RVUs in Texas
Color or red-free photographs of the retina, optic disc, and posterior pole, reviewed with a written report, document and track posterior segment eye disease.
Medicare pays $34.92–$38.38 for 92250 in the office in Texas, from Beaumont to Austin. 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 92250 covers
Fundus photography uses a retinal camera, often after pupil dilation, to capture images of the optic nerve head, macula, retinal vessels, and visible peripheral retina. An ophthalmic photographer or technician acquires the images, and an ophthalmologist or optometrist interprets them and writes a report. It is performed mainly in eye clinics and ophthalmology offices to establish a baseline or monitor conditions such as diabetic retinopathy, age-related macular degeneration, choroidal nevi, retinal vascular occlusions, and glaucomatous optic disc changes.
Report one unit for a session whether one or both eyes are photographed. CMS prices 92250 as bilateral, so modifier 50 does not increase payment. The record should identify the clinical reason, eyes imaged, and interpreted findings. Billing without a component modifier represents the global service; modifier 26 identifies the interpretation, and modifier TC identifies the camera, staff, and other technical work when components are billed separately. When 92250 is performed with other eligible ophthalmology diagnostic tests, the ophthalmology diagnostic multiple procedure reduction applies to its technical component.
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.
Where 92250 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$34.92 to $38.38
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $38.38 | Unavailable |
| Beaumont | $34.92 | Unavailable |
| Brazoria | $36.82 | Unavailable |
| Dallas | $37.00 | Unavailable |
| Fort Worth | $36.78 | Unavailable |
| Galveston | $36.90 | Unavailable |
| Houston | $37.27 | Unavailable |
| Rest Of Texas | $35.82 | Unavailable |
How the 92250 rate is calculated
Each of 92250’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 · 92250
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.39Practice expense 0.70Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 92250
The CMS indicators that decide how 92250 is paid alongside other services.
CMS payment indicators · 92250
Fundus photography
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 7 | Diagnostic ophthalmology reduction applies to the technical component. |
| 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 | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
92250 without 26 · national office
$37.07
Fundus photography
92250-26 · Professional component
$20.37
Pays only the interpretation and report.
92250 compared with similar codes
Compare codes
92250 vs 92228 vs 92201 vs 92235 vs 92285: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 92228Retinal imaging
- 92228 covers remote retinal imaging for disease detection or monitoring with physician or qualified professional review. Use 92250 for diagnostic fundus photographs with interpretation and report; do not report both for the same images.
- 92201Extended ophthalmoscopy
- 92201 is an extended retinal examination documented with a detailed drawing; 92250 documents the fundus with photographs. If both are performed, each needs separate clinical support and documentation.
- 92235Fluorescein angiography
- 92235 uses fluorescein dye and sequential angiographic images to assess retinal circulation and leakage; 92250 captures non-contrast color or red-free fundus photographs.
- 92285External eye photography
- 92285 photographs external ocular structures such as the eyelids, conjunctiva, or cornea; 92250 images the internal fundus, including the optic disc, macula, vessels, and visible periphery.
92250 billing questions
Should fundus photography be billed once or twice when both eyes are photographed?
Once. The code is priced as bilateral, so a single unit covers one or both eyes, and modifier 50 does not increase payment.
Can fundus photography and extended ophthalmoscopy be billed on the same date?
Same-day billing requires separately performed, medically necessary services supported by their own documentation. Fundus photographs alone do not establish the extended examination and detailed drawing required for 92201 or 92202.
When is 92250 used instead of retinal imaging codes 92227–92229?
Use 92250 for diagnostic fundus photographs with a clinical interpretation and report. Codes 92227 and 92228 describe remote retinal imaging with different reviewers; 92229 describes point-of-care imaging with automated analysis. Select the code that matches the service performed rather than reporting both for the same images.
How is the service split between an imaging site and the reading clinician?
The entity furnishing the camera and staff reports the technical service with modifier TC; the clinician who interprets the images and reports findings uses modifier 26. An entity furnishing both components reports the global service without either modifier.
Does a multiple procedure reduction affect fundus photography?
When 92250 is performed with other tests subject to the ophthalmology diagnostic multiple procedure reduction, CMS applies the reduction to the technical component.
What documentation supports the interpretation portion?
A signed interpretation should identify the indication and eyes imaged and describe relevant findings, such as hemorrhages, drusen, or optic disc cupping. Note image quality or comparisons with prior photographs when they affect interpretation.
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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