$86.89
92012 covers an intermediate examination of an established patient. Choose 92014 when the documented examination meets the comprehensive scope and initiates or continues a diagnostic or treatment plan.
On this page
CMS RVU26D · Effective 2026-10-01
92014 Comprehensive eye exam Medicare reimbursement rates in Utah
Report a comprehensive ophthalmic evaluation of an established patient when the visual system is assessed and a diagnostic or treatment plan is initiated or continued. Compare 92014 office and facility rates across CMS payment localities in Utah.
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 92014 in Utah?
Utah 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
$122.41
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
$61.19
1 of 1 localities have a supported rate.
Payment area: Utah
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 92014: Comprehensive eye exam, established patient
Report a comprehensive ophthalmic evaluation of an established patient when the visual system is assessed and a diagnostic or treatment plan is initiated or continued.
An ophthalmologist or optometrist performs this comprehensive assessment for an established patient, usually in an eye care office. Established status depends on professional services within the preceding three years from the clinician or a clinician of the same specialty and subspecialty in the same group. The evaluation addresses the visual system through history, general medical observation, external and ophthalmoscopic examinations, gross visual fields, and a basic sensorimotor assessment. Slit-lamp examination, tonometry, or dilation may be included when indicated. Common medical reasons include glaucoma follow-up, cataract evaluation, and diabetic retinopathy monitoring.
Report 92014 once for the comprehensive service, even if completed over multiple visits; use 92012 for an intermediate examination. The record should support the examination scope, medical reason, and initiation or continuation of a diagnostic or treatment plan. Medicare does not cover routine eye exams without a medical indication. Refraction, when performed, is separately reported with 92015 and excluded from Medicare coverage; medically necessary visual field testing or retinal imaging may also be reported separately. The code covers one or both eyes and is already priced as bilateral, so modifier 50 does not increase payment.
CMS billing rules for 92014
- Bilateral procedures
- The code is already priced as bilateral; modifier 50 does not increase payment.
Where the value comes from
- Work RVU1.42 · 37%
- Practice expense (office) RVU2.35 · 62%
- Malpractice RVU0.04 · 1%
9.2M
Medicare services in 2024 · #22 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.
92014 compared with similar codes
Office rates for Utah, from the same CMS release.
$144.25
Both cover comprehensive eye exams. 92004 is for a new patient; 92014 is for a patient who received professional services from the provider or a same-specialty and subspecialty group member within the preceding three years.
92015
No office rateDetermine refractive state
92015 reports refraction to determine the eye's refractive state, not a comprehensive ophthalmic examination. Report it separately when performed; Medicare excludes refraction from coverage.
$131.12
99214 is an office E/M visit selected by medical decision making or time. 92014 is selected by comprehensive ophthalmic examination content. Do not report both for the same examination.
Compare 92014 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
Utah →
Office / nonfacility
$122.41
Facility
$61.19
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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 92014 in Utah.
PPRRVU2026_Oct_nonQPP.csv
11,662
- Code
- 92014
- Physician work
- 1.42
- Practice expense
- 2.35
- Malpractice
- 0.04
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.42 | × 1.000 | 1.4200 |
| Practice expense | 2.35 | × 0.940 | 2.2090 |
| Malpractice | 0.04 | × 0.898 | 0.0359 |
| Total RVUs | 3.6649 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$122.41
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.42 | 1 |
| Practice expense | 2.35 | 0.94 |
| Malpractice | 0.04 | 0.898 |
(1.42 × 1 + 2.35 × 0.94 + 0.04 × 0.898) × $33.4009 = $122.41
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.42 | 1 |
| Practice expense | 0.4 | 0.94 |
| Malpractice | 0.04 | 0.898 |
(1.42 × 1 + 0.4 × 0.94 + 0.04 × 0.898) × $33.4009 = $61.19
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.
92014 billing questions
When should 92014 be chosen over 92012?
Use 92014 when the documented examination covers the comprehensive visual system assessment and initiates or continues a diagnostic or treatment plan. Use 92012 for an intermediate examination that does not meet that comprehensive scope.
Is refraction included in 92014?
No. Report a separately performed refraction with 92015; Medicare excludes refraction from coverage.
Should modifier RT, LT, or 50 be appended?
Routine reporting of 92014 does not require RT or LT; document the eye or eyes examined. The code covers one or both eyes and is already priced as bilateral, so modifier 50 does not increase payment.
Can an office E/M code be billed instead of 92014?
Yes. An eye care provider may report an office E/M code instead when its documentation requirements are met. Do not report both an office E/M code and 92014 for the same examination.
What qualifies the patient as established for this code?
The patient has received professional services within the preceding three years from the provider or another provider of the same specialty and subspecialty in the same group. If the patient is new, consider 92004 when a comprehensive ophthalmic examination is performed.
Does Medicare pay for an annual comprehensive exam with no complaints?
An annual schedule alone does not establish coverage. A medically indicated examination, such as glaucoma surveillance or diabetic retinal disease monitoring, may qualify even without new complaints; routine vision screening is not covered.
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.
11,65992002,,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
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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985