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.
For related coverage guidance, see recent payer policy updates: Corneal Remodeling for Refractive Errors and Corneal Grafting and Transplantation, Glaucoma Agents iDose TR (travoprost intracameral implant), Topical Treatments for Dry Eye Disease.
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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.