# CPT 92004: Ophthalmological examination, new patient, comprehensive

Medicare CPT 92004 pays $149.64 in a non-facility setting and $77.82 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $136.65 in Arkansas to $185.12 in Alaska, a 35% spread.

Web page: https://www.med-reveal.com/rates/92004-cpt-fee-schedule
Section: Vision and Hearing Services
Billed by: Ophthalmology, Optometrist

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $149.64 |
| National facility | $77.82 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $185.12 | $108.64 |
| District of Columbia | $168.65 | $84.05 |
| California | $167.24 | $82.27 |
| New Jersey | $163.91 | $83.05 |
| Washington | $163.53 | $81.66 |
| New York | $163.11 | $83.00 |
| Massachusetts | $161.97 | $81.29 |
| Hawaii | $161.06 | $79.41 |
| Connecticut | $157.87 | $80.53 |
| Colorado | $155.67 | $79.27 |
| Oregon | $154.44 | $78.78 |
| Maryland | $154.25 | $79.39 |
| Rhode Island | $153.53 | $79.35 |
| New Hampshire | $153.06 | $78.30 |
| Minnesota | $151.23 | $77.34 |
| Florida | $151.19 | $79.14 |
| Puerto Rico | $150.58 | $77.98 |
| Virgin Islands | $150.58 | $77.98 |
| Montana | $149.63 | $77.82 |
| Nevada | $149.50 | $77.62 |
| Wyoming | $149.29 | $77.48 |
| North Dakota | $148.84 | $77.03 |
| Delaware | $148.75 | $77.80 |
| South Dakota | $148.75 | $76.94 |
| Texas | $148.52 | $77.82 |
| Pennsylvania | $148.49 | $78.14 |
| Illinois | $148.11 | $78.72 |
| Vermont | $148.10 | $77.01 |
| Virginia | $147.76 | $77.16 |
| Arizona | $146.73 | $77.15 |
| Georgia | $145.97 | $77.46 |
| Maine | $145.25 | $76.63 |
| Wisconsin | $145.04 | $76.24 |
| Michigan | $144.84 | $77.41 |
| Utah | $144.25 | $76.75 |
| North Carolina | $143.29 | $76.29 |
| South Carolina | $142.78 | $76.43 |
| New Mexico | $142.64 | $76.79 |
| Indiana | $142.56 | $75.99 |
| Missouri | $142.41 | $76.51 |
| Louisiana | $142.09 | $76.52 |
| Nebraska | $142.07 | $75.78 |
| Ohio | $142.03 | $76.47 |
| Idaho | $141.93 | $75.86 |
| Iowa | $141.39 | $75.68 |
| Tennessee | $141.05 | $75.78 |
| Kansas | $140.57 | $75.65 |
| Oklahoma | $139.97 | $75.85 |
| Kentucky | $139.81 | $75.97 |
| West Virginia | $138.75 | $76.34 |
| Alabama | $138.12 | $75.28 |
| Mississippi | $137.12 | $75.29 |
| Arkansas | $136.65 | $74.96 |

## Related codes

- 92002: Ophthalmological examination, new patient, intermediate — https://www.med-reveal.com/rates/92002-cpt-fee-schedule
- 92012: Ophthalmological examination, established patient, intermediate — https://www.med-reveal.com/rates/92012-cpt-fee-schedule
- 92014: Ophthalmological examination, established patient, comprehensive — https://www.med-reveal.com/rates/92014-cpt-fee-schedule
- 92018: Ophthalmological examination and evaluation, under general anesthesia, complete — https://www.med-reveal.com/rates/92018-cpt-fee-schedule
- 92019: Ophthalmological examination and evaluation, under general anesthesia, limited — https://www.med-reveal.com/rates/92019-cpt-fee-schedule
- 92225: Ophthalmoscopy, extended, with retinal drawing, initial — https://www.med-reveal.com/rates/92225-cpt-fee-schedule
- 92226: Ophthalmoscopy, extended, with retinal drawing, subsequent — https://www.med-reveal.com/rates/92226-cpt-fee-schedule
- 92499: Unlisted ophthalmological service or procedure — https://www.med-reveal.com/rates/92499-cpt-fee-schedule

Commercial negotiated rates for 92004 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules