CPT 92229
Contractor-priced
92229 · PFS Q1 2021 · Historical
No national PFS rate in Q1 2021
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Not at a published national rate. CPT 92229 carries status C (carrier-priced) in the Q1 2021 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Treat the blank amount as unpriced, not as $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 92229
- Release
- Q1 2021, revision 1
- Result
- Contractor-priced
Citations
-
Establishes the PFS status (C) and the resulting pathway for this code: contractor-priced.
Physician relative value file (PPRRVU)Q1 2021 · revision 1
Latest revision of this release
Release period: January 1 – March 31, 2021
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU21_JAN.csv in rvu21a-updated-01052021.zip (row 15,913)- hcpcs (col 1)
- 92229
- modifier (col 2)
- blank
- status_code (col 4)
- C
SHA-256: 8e6212d64ca58c6a20c44ea319d2148c49156b1fe63a6b68e64a5b0695b0e674
Why is there no national PFS amount for 92229?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Carrier-priced: no national payment amount.
Payment considerations Copy link
Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.
Other payment indicators (6)
Facility/non-facility: Not determined, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply.
Reconciling a contractor-priced payment for 92229 Copy link
There is no national allowed amount for 92229, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.
What to reconcile
- Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
- Only a technical-component amount is published for this code, so a professional charge billed on it has no fee-schedule amount behind it.
- Check for a second ophthalmology diagnostic line on the same date: the lower-ranked technical component is reduced by rule, while the professional component is never reduced.
- Check whether a second side was billed separately—the published RVUs already price both sides, so there is no additional amount behind that line.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Nearby payment lines
National Q1 2021 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
No comparison lines are present in this release.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04); CMS Transmittal R1149OTN: MPPR on the Technical Component of Diagnostic Cardiovascular and Ophthalmology Procedures.
Global period: what 92229's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
What 92229's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 2 | RVUs already reflect bilateral pricing. The published RVUs already account for a bilateral procedure—no additional bilateral adjustment applies on top of the fee schedule amount. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 7 | Ophthalmology reduction applies. The technical component of the second and subsequent ranked diagnostic ophthalmology procedure on the same day is reduced; the professional component is never reduced. |
| Professional/technical split | 3 | Technical component only. Only a technical component exists for this code—there is no corresponding professional-component amount to bill. |
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 92229.
Common payment questions Copy link
Why would a Medicare claim for 92229 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- Only a technical component exists for 92229—there is no professional-component amount to bill. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
The 92229 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
How often 92229 is billed Copy link
Across Original Medicare in CY2024, 92229 ranked #2,892 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2021 fee schedule above.
Did this answer your question about CPT 92229?
We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.
Source & method
Show sources
Hide
Contractor amounts come from the MAC-published schedules and effective dates identified above. The PFS file establishes contractor pricing. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This citation identifies the source release, so its evidence remains reproducible after a newer release lands.
CPT 92229 National PFS baseline: No national PFS rate (Q1 2021; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/92229/2021/A