Billing code 92134: Retinal OCTMedicare rate & RVUs in Washington
Computerized scanning imaging of the retina, typically macular optical coherence tomography, is reported for an interpreted study of one or both eyes.
Medicare pays $33.86–$38.06 for 92134 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 92134 covers
This service uses computerized scanning imaging of the posterior retina, most often optical coherence tomography (OCT) of the macula. Ophthalmologists and optometrists use it to assess retinal thickness and layers in age-related macular degeneration, diabetic macular edema, retinal vein occlusion, macular holes, epiretinal membranes, and vitreomacular traction; OCT also supports hydroxychloroquine toxicity screening. A technician obtains the images in an eye care office or clinic, and the interpreting clinician documents retinal findings. Imaging directed at the optic nerve rather than the retina belongs to 92133.
Report one unit for one or both eyes at a session; CMS prices the code as bilateral, and modifier 50 does not increase payment. The report should identify the eyes examined, clinically relevant findings, and comparison with prior imaging when available. Modifier 26 identifies interpretation alone; modifier TC identifies equipment and staff services alone. Bill globally without either modifier when the billing entity furnishes both components. When multiple eligible ophthalmic diagnostic tests are performed, CMS's ophthalmology diagnostic multiple procedure reduction affects the technical component. Choose 92137 instead when documented OCT angiography is part of the retinal study.
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 92134 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $33.86 | Unavailable |
| Seattle (King Cnty) | $38.06 | Unavailable |
How the 92134 rate is calculated
Each of 92134’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 · 92134
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.31Practice expense 0.65Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 92134
The CMS indicators that decide how 92134 is paid alongside other services.
CMS payment indicators · 92134
Retinal OCT
| 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
92134 without 26 · national office
$32.73
Retinal OCT
92134-26 · Professional component
$17.70
Pays only the interpretation and report.
92134 compared with similar codes
Compare codes
92134 vs 92133 vs 92137 vs 92250: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 92133Optic nerve OCT
- 92133 images the optic nerve head and nerve fiber layer for glaucoma or optic neuropathy; 92134 images the retina and macula. Select according to the documented imaging target.
- 92137OCT angiography
- 92137 addresses retinal imaging with OCT angiography; report 92134 when the retinal study consists of structural scanning imaging without OCT angiography.
- 92250Fundus photography
- 92250 produces fundus photographs of the retina, while 92134 produces cross-sectional scanning images used to assess retinal layers and thickness.
92134 billing questions
Should one unit or two be reported when both eyes are scanned?
Report one unit for the session. The code covers one or both eyes and is priced as bilateral, so modifier 50 or a second unit for the other eye does not increase payment.
Can retinal OCT and optic nerve OCT be billed on the same day?
92134 addresses retinal imaging, while 92133 addresses optic nerve imaging. Do not report both for a single scan; each requires a distinct, documented study of its respective target.
When is modifier 26 or TC used?
Use modifier 26 when billing only the interpretation and modifier TC when billing only the equipment and staff portion. Bill the global code without either modifier when the billing entity furnishes both components.
Can 92134 be reported with OCT angiography of the retina?
Code 92137 describes retinal OCT angiography. Report 92137 instead of 92134 when the documented retinal study includes OCT angiography.
Is it billable on the same day as an intravitreal injection?
Yes. Macular OCT may be performed before an anti-VEGF injection (67028) to assess fluid and guide treatment; report the interpreted test separately when medically necessary.
What documentation supports the interpretation?
A signed report should identify the eyes imaged and findings such as retinal fluid or thickness, with comparison to prior studies when available. Image printouts without a written interpretation do not support the professional component.
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
Show the CMS file lines behind this rate
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