Procedure · Updated Aug 1, 2026

Eye exam: CPT code and Medicare rate

A comprehensive eye evaluation for a new patient, covering the full examination rather than a single focused problem.

Also called: vision exam, comprehensive eye exam, ophthalmology visit, eye doctor visit.

Usually billed as

92004 New Patient Eye Examination, Comprehensive

Office (non-facility): $149.64
Facility: $77.82

National amounts for the Q4 2026 release (October 1 – December 31, 2026), using geographic index values of 1.000. Your local rate differs; the code page has the locality breakdown.

Traditional Medicare does not cover routine eye exams for glasses. It covers eye examinations done to diagnose or manage a medical eye condition.

Common questions Copy link

Eye exam: which code is it?

92004—New Patient Eye Examination, Comprehensive. A comprehensive eye evaluation for a new patient, covering the full examination rather than a single focused problem.

Eye exam: how much does Medicare pay?

Nationally, the Q4 2026 Physician Fee Schedule pays $149.64 in an office (non-facility) setting and $77.82 in a facility setting for 92004. Your local amount differs—the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.

Eye exam: what else affects the billing?

Traditional Medicare does not cover routine eye exams for glasses. It covers eye examinations done to diagnose or manage a medical eye condition.

Need the rate where you practice?

Every code page carries the full locality breakdown, the RVU and GPCI inputs, and the release the numbers come from.

Open the code page

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All procedures How Medicare pays Office vs. facility rates Check a medical bill

This page maps everyday language to the code a claim normally carries. It's general information about how Medicare prices a service, not coding advice for a specific claim. The correct code always depends on what was actually documented and performed.

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