CPT 92002: Intermediate Ophthalmological Evaluation, New Patient
Medicare pays $88 and commercial payers pay $167 on average nationally for this procedure.
CPT code 92002 describes an intermediate ophthalmological evaluation for a new patient in which the provider performs an eye examination, initiates a diagnostic and treatment program, and documents findings and plan; the service is typically delivered as an office or clinic-based ophthalmology visit involving diagnostic assessment and management steps for a new patient encounter.
Customize your policy alerts
Sign up for cpt 92002 policy alerts
Get alerted when payer policies referencing 92002 are released or updated.
Monitor payer policy activity
National Reimbursement Benchmarks
Medicare’s mean allowed rate of $88.2 sits below BUCA’s average commercial benchmark of $166.5, indicating that average commercial payments in BUCA are roughly $78.3 higher than Medicare for this CPT. That gap highlights a meaningful separation between public and average commercial reimbursement levels for this service.
Dispersion (P75−P25) varies notably across payers. Blue Cross Blue Shield shows the widest interquartile spread at $91.8 ($274.6−$182.8), followed by BUCA at $78.2 ($206.2−$128.0) and UnitedHealth Group at $58.6 ($124.5−$65.9). Aetna and Cigna are tighter by comparison, with ranges of $52.5 ($92.5−$39.0) and $63.9 ($128.0−$60.3) respectively. Medicare’s IQR is narrow at $9 ($91−$82), reflecting relatively consistent allowed amounts across localities.