CPT 92012
Global XXX ActiveIntrm oph exam est patient
CPT 92012 Billing & Documentation Guide
CPT code 92012 (Intrm oph exam est patient) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.92, a non-facility practice expense RVU of 1.76, and a malpractice RVU of 0.03, a total non-facility RVU of 2.71 and facility RVU of 1.24. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $93.57, though rates vary from $81.74 to $119.41 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92012, 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 92012 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 92012 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 92012
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.92 | 0.92 |
| Practice Expense RVU | 1.76 | 0.29 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 2.71 | 1.24 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92012
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 | $101.93 | $43.83 | $96.22 - $119.41 | 29 |
| Florida | $91.66 | $42.4 | $88.43 - $94.46 | 3 |
| Georgia | $88.06 | $41.22 | $84.36 - $91.75 | 2 |
| Illinois | $89.55 | $42.11 | $85.97 - $93.09 | 4 |
| Michigan | $87.34 | $41.24 | $85.53 - $89.15 | 2 |
| North Carolina | $86.22 | $40.41 | $86.22 - $86.22 | 1 |
| New York | $99.13 | $44.35 | $87.28 - $104.45 | 5 |
| Ohio | $85.41 | $40.58 | $85.41 - $85.41 | 1 |
| Pennsylvania | $89.66 | $41.57 | $85.64 - $93.67 | 2 |
| Texas | $89.7 | $41.37 | $85.15 - $93.87 | 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 92012
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92012 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 |
| 0548T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0567T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0568T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0569T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0570T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0571T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0572T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 92012
What does CPT code 92012 mean? +
CPT code 92012 represents: Intrm oph exam est patient. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92012? +
The 2026 Medicare national average non-facility payment for CPT 92012 is $93.57. Rates range from $81.74 to $119.41 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92012? +
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 92012? +
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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