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CPT 92002: Intermediate Ophthalmological Evaluation, New Patient
CPT code 92002 denotes an intermediate ophthalmological evaluation for a new patient, during which a clinician conducts a focused ocular history and exam, performs limited diagnostic testing as needed, and initiates a diagnostic and treatment program. This code is a fundamental billing descriptor for ambulatory ophthalmology services, distinguishing intermediate new-patient assessments from comprehensive evaluations and established-patient visits. Nationally, accurate use of 92002 affects care capture, coding compliance, and revenue integrity for practices that provide eye examinations and management for new patients.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 92002, comparisons to related ophthalmology evaluation codes, and the common settings where the service is provided. The publication outlines billing considerations, coding relationships to comprehensive and established-patient ophthalmological services, and typical clinical indications that align with intermediate-level new-patient care.
This summary serves clinicians, billing professionals, and policy analysts seeking clarity on when 92002 is reported, how it fits within the ophthalmology service line, and what associated operational and coding topics to review for documentation and compliance.
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Billing Code Overview
CPT code 92002 describes an intermediate ophthalmological evaluation for a new patient in which the provider establishes a diagnostic and treatment plan. The service typically includes a targeted history, examination of the eyes and related structures, basic diagnostic testing as clinically indicated, and initiation of treatment or management steps.
Service type: Intermediate ophthalmological evaluation (new patient)
Typical site of service: Office or clinic-based ophthalmology setting
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.