Eye & ear

92004 - RVUs & Medicare payment (2026)

Eye exam, new patient, comprehensive.

Component	Non-facility	Facility
Work RVU	1.82	1.82
Practice expense RVU	2.62	0.47
Malpractice RVU	0.04	0.04
Total RVUs	4.48	2.33
National payment (CF $33.4009)	$149.64	$77.82
Qualifying APM payment (CF $33.5675)	$150.38	$78.21

How 92004 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 92004 ranges from $136.65 in Arkansas (AR) to $194.38 in San Jose-Sunnyvale-Santa Clara (CA); calculate 92004 for your locality.

San Jose-Sunnyvale-Santa Clara (CA) $194.38 San Jose-Sunnyvale-Santa Clara (CA) $194.20 San Francisco-Oakland-Berkeley (CA) $190.57 San Francisco-Oakland-Berkeley (CA) $190.52 Alaska (AK) $185.12 Napa (CA) $180.64 Vallejo (CA) $180.57 Seattle (WA) $172.30 National average $149.64 … 97 more localities between … Alabama (AL) $138.12 Rest Of Missouri (MO) $137.52 Mississippi (MS) $137.12 Arkansas (AR) $136.65

Non-facility payment for 92004 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - eye & ear

92002 · eye exam, new patient, intermediate
92012 · eye exam, established patient, intermediate
92014 · eye exam, established patient, comprehensive
92083 · visual field examination, extended
92134 · optical coherence tomography (oct), retina
66984 · cataract removal with intraocular lens insertion
92557 · comprehensive hearing test (audiometry)

Frequently asked questions

How much does Medicare pay for 92004 in 2026?

The national non-facility payment is $149.64 and the facility payment is $77.82, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 92004?

The 2026 work RVU for 92004 is 1.82. Total RVUs are 4.48 in the non-facility setting and 2.33 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.