CPT 92004
Global XXX ActiveCompre oph exam new pt 1/>
CPT 92004 Billing & Documentation Guide
CPT code 92004 (Compre oph exam new pt 1/>) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.82, a non-facility practice expense RVU of 2.62, and a malpractice RVU of 0.04, a total non-facility RVU of 4.48 and facility RVU of 2.33. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $154.51, though rates vary from $136.65 to $194.38 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92004, 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 92004 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 92004 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 92004
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.82 | 1.82 |
| Practice Expense RVU | 2.62 | 0.47 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 4.48 | 2.33 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92004
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 | $167.24 | $82.27 | $158.45 - $194.38 | 29 |
| Florida | $151.19 | $79.14 | $146.46 - $155.27 | 3 |
| Georgia | $145.97 | $77.46 | $140.44 - $151.49 | 2 |
| Illinois | $148.11 | $78.72 | $142.77 - $153.46 | 4 |
| Michigan | $144.84 | $77.41 | $142.19 - $147.49 | 2 |
| North Carolina | $143.29 | $76.29 | $143.29 - $143.29 | 1 |
| New York | $163.11 | $83 | $144.86 - $171.21 | 5 |
| Ohio | $142.03 | $76.47 | $142.03 - $142.03 | 1 |
| Pennsylvania | $148.49 | $78.14 | $142.39 - $154.58 | 2 |
| Texas | $148.52 | $77.82 | $141.67 - $154.68 | 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 92004
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92004 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 |
| 92020 | Column 1 (primary), can be billed with modifier | 9 | CPT Separate procedure definition |
| 92060 | Column 1 (primary), can be billed with modifier | 9 | CPT Separate procedure definition |
| 92100 | Column 1 (primary), can be billed with modifier | 9 | CPT Separate procedure definition |
| 92120 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 92137 | Column 1 (primary), can be billed with modifier | 9 | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 92004
What does CPT code 92004 mean? +
CPT code 92004 represents: Compre oph exam new pt 1/>. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92004? +
The 2026 Medicare national average non-facility payment for CPT 92004 is $154.51. Rates range from $136.65 to $194.38 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92004? +
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 92004? +
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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