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Medicare Physician Fee Schedule · Q3 2026 release

CPT 92012 in Louisville, KY 15102-00

Established patient eye examination, intermediate in ZIPs including 40202, 40507, and 40203

92012 2026 C · Louisville, KY flag15102-00 A Active
Allowed amount
$83.91
in a doctor’s own office or clinic

92.7% of the $90.52 national baseline

Medicare payment
$67.13
Patient / secondary
$16.78
Expected total to provider
$83.91

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 92012 in Louisville, KY? Copy link

The Medicare allowed amount is $83.91 in the office (non-facility) setting and $40.26 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 7.3% below the national baseline, and the facility amount is 2.8% below the national baseline. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied — not necessarily what a specific claim pays.

What Medicare locality is Louisville, KY in? Copy link

CMS prices all of Kentucky as one Medicare payment locality, so this amount applies statewide, including Lexington, Bowling Green and Covington — not only in Louisville, KY.

Why Louisville, KY differs from the national amount Copy link

Louisville, KY (this locality)
$83.91
National PFS baseline (GPCI 1.000)
$90.52

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts Louisville, KY at 7.3% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.889
Malpractice GPCI
0.915
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 92012 in Louisville, KY: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Louisville, KY allowed amount for 92012
Component RVU × GPCI = Adjusted RVU
Work 0.92 1.000 0.9200
Practice expense 1.76 0.889 1.5646
Malpractice 0.03 0.915 0.0275
Sum of adjusted RVUs 2.5121
× $33.4009 2026 conversion factor $83.91

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Louisville, KY allows $40.26 for 92012, versus $83.91 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Louisville, KY. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 92012 in Louisville, KY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $83.91
Non-participating allowed amount 95% of the participating amount. $79.71
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $91.67
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $67.13
Beneficiary coinsurance The remaining 20%. $16.78
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $1.34
Medicare pays after sequestration Program payment net of the sequestration reduction. $65.79

Contracted rate: % of Medicare in Louisville, KY Copy link

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $83.91 in the office (non-facility) setting — not the $90.52 national baseline.

Opens the calculator already set to Louisville, KY and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this Louisville, KY rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 1,030 ZIP codes to this payment locality. 92012 prices identically in every one of them. 2 of them span more than one locality and need ZIP+4 for an exact match.

40003 40004 40006 40007 40008 40009 40010 40011 40012 40013 40014 40018 40019 40020 40022 40023 40025 40026 40027 40031 40032 40033 40036 40037 40040 40041 40045 40046 40047 40048 40049 40050 40051 40052 40055 40056 40057 40058 40059 40060 40061 40062 40063 40065 40066 40067 40068 40069 40070 40071 40075 40076 40077 40078 40104 40106 40107 40108 40109 40110 40111 40115 40117 40118 40119 40121 40122 40129 40140 40142 40143 40144 40145 40146 40150 40152 40153 40155 40157 40159 40160 40161 40162 40164 40165 40166 40170 40171 40175 40176 40177 40178 40201 40202 40203 40204 40205 40206 40207 40208

930 more ZIP codes map to this locality. The Louisville, KY locality page lists the full set.

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

92012 in nearby payment localities Copy link

Payment localities in the same region as Louisville, KY, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 92012. Proximity doesn't imply similar pricing — neighbouring localities often differ.

92012 allowed amount in payment localities near Louisville, KY
Metro Allowed amount vs. Louisville, KY
Indianapolis, IN $85.71 +2.1%
Nashville, TN $84.70 +0.9%
Columbus, OH $85.41 +1.8%
St. Louis, MO $87.70 +4.5%
Chicago, IL $92.32 +10.0%
Detroit, MI $89.15 +6.2%

Every payment locality nationwide is on the CPT 92012 rate map.

Other codes priced in Louisville, KY Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in Louisville, KY
Code Service Louisville, KY vs. national
92014 Full Eye Exam, Returning Patient $118.43 -6.9%
92004 New Patient Eye Examination, Comprehensive $139.81 -6.6%
67028 Intravitreal Medication Injection $106.84 -6.5%
92134 Retina Scan $30.27 -7.5%
99213 Routine Follow-Up Office Visit $89.52 -6.0%
99214 Long Follow-Up Office Visit $127.80 -5.8%
66984 Cataract Surgery $438.31 -5.3%
99204 Long New Patient Office Visit $167.52 -5.5%
99212 Brief Follow-Up Office Visit $55.50 -6.6%
99215 Longest Follow-Up Office Visit $181.60 -5.6%
97110 Physical Therapy Exercises $27.51 -5.3%
99203 New Patient Office Visit $110.59 -5.9%

Common questions Copy link

Which ZIP codes does the Louisville, KY rate for 92012 cover?
The CMS ZIP-to-locality crosswalk maps 1,030 ZIP codes to this payment locality, and every one of them prices 92012 identically. Examples include 40003, 40004, 40006, 40007, 40008, 40009. 2 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 92012 rate in Louisville, KY different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices — work 1.000, practice expense 0.889, malpractice 0.915 — scale each RVU component before the conversion factor is applied, which is why Louisville, KY allows less than the $90.52 baseline.
Does this 92012 rate apply everywhere in Kentucky?
Yes. CMS prices Kentucky as a single Medicare payment locality, so the same GPCIs — and the same allowed amount — apply statewide, not only in Louisville, KY. That includes Lexington, Bowling Green and Covington. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.
What is the facility rate for 92012 in Louisville, KY?
$40.26 in a facility, versus $83.91 in the office (non-facility) setting — a $43.65 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 92012 in Louisville, KY?
A non-participating provider is paid $79.71 — 95% of the $83.91 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $91.67, which is 115% of the non-participating amount.
How much of the Louisville, KY 92012 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($67.13) once the annual Part B deductible is met, and the beneficiary owes 20% ($16.78). Sequestration reduces Medicare's share by about 2% ($1.34), leaving $65.79. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release : this code's RVUs from the relative value file, multiplied by payment locality 15102-00's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 11,600)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 55)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 92012 in Louisville, KY against the release that governed that date. Past releases need a free account; today's rate does not.

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