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CPT 92012: Intermediate Eye Exam for Established Patients
CPT code 92012 denotes an intermediate-level ophthalmological examination for an established patient and is widely used in outpatient eye care. It captures visits that require more focused assessment than problem-focused exams but do not meet the scope of a comprehensive medical ophthalmologic evaluation. Nationally, this code matters because it aligns clinical documentation with billing for routine follow-up and problem-oriented visits in ophthalmology practices, affecting revenue cycle workflows and coding compliance.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of payer coverage patterns and typical use cases for 92012, comparison to related ophthalmology services, and the clinical context in which the code is applied (follow-up evaluations, targeted problem assessment, and management of chronic ocular conditions). The publication also outlines common documentation elements required to support this intermediate-level service and highlights related codes commonly encountered alongside 92012.
This summary is intended for a national audience of providers, coding professionals, and policy analysts seeking concise information on clinical use, billing context, and payer relevance for CPT code 92012. Data not available in the input.
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Billing Code Overview
CPT code 92012 describes an intermediate ophthalmological examination for an established patient. The service is provided by an ophthalmologist or other qualified eye care clinician to evaluate ocular health and visual function when the visit does not meet criteria for a comprehensive exam. An established patient is generally one who has received a face-to-face service from the same physician, any physician in the same group practice, or another physician of the same specialty billing under the same group number within the past 36 months.
Service type: Ophthalmological intermediate-level evaluation and management
Typical site of service: Outpatient clinic or physician office (ophthalmology practice)
National Reimbursement Benchmarks
Medicare averages about $94.10 for CPT 92012, while BUCA’s mean commercial rate sits higher at $141.70, a difference of $47.60. This places BUCA well above Medicare on average, with the commercial mean closer to the mid-to-upper range among national payers and Medicare anchored near the lower-middle of the national distribution.
Dispersion (P75 minus P25) highlights variability by payer: Blue Cross Blue Shield shows the widest interquartile spread at $73.00 ($211.60 − $138.60), followed by UnitedHealth Group at $63.50 ($133.50 − $69.80) and Cigna at $69.10 ($135.50 − $64.10). Aetna’s spread is $62.80 ($107.10 − $47.30). BUCA’s IQR is $69.50 ($174.60 − $105.10). Medicare’s P75 − P25 is relatively tight at $9.00 ($97 − $88).