CPT 92002
Global XXX ActiveIntrm oph exam new patient
CPT 92002 Billing & Documentation Guide
CPT code 92002 (Intrm oph exam new patient) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.88, a non-facility practice expense RVU of 1.64, and a malpractice RVU of 0.02, a total non-facility RVU of 2.54 and facility RVU of 1.13. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $87.73, though rates vary from $76.79 to $111.97 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92002, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 92002 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 92002 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 92002
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.88 | 0.88 |
| Practice Expense RVU | 1.64 | 0.23 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 2.54 | 1.13 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92002
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $95.63 | $39.9 | $90.29 - $111.97 | 29 |
| Florida | $85.65 | $38.4 | $82.76 - $88.11 | 3 |
| Georgia | $82.5 | $37.57 | $79.05 - $85.94 | 2 |
| Illinois | $83.7 | $38.2 | $80.45 - $87.04 | 4 |
| Michigan | $81.77 | $37.55 | $80.16 - $83.38 | 2 |
| North Carolina | $80.93 | $36.99 | $80.93 - $80.93 | 1 |
| New York | $92.8 | $40.27 | $81.9 - $97.64 | 5 |
| Ohio | $80.08 | $37.08 | $80.08 - $80.08 | 1 |
| Pennsylvania | $84.03 | $37.9 | $80.31 - $87.74 | 2 |
| Texas | $84.1 | $37.74 | $79.86 - $88 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 92002
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92002 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0115T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0116T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0469T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92004 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 92014 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 92018 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 92019 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 92020 | Column 1 (primary), can be billed with modifier | 9 | CPT Separate procedure definition |
Frequently Asked Questions, CPT 92002
What does CPT code 92002 mean? +
CPT code 92002 represents: Intrm oph exam new patient. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92002? +
The 2026 Medicare national average non-facility payment for CPT 92002 is $87.73. Rates range from $76.79 to $111.97 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92002? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 92002? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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