CPT 92019
Global XXX ActiveLmtd oph exam general anes
CPT 92019 Billing & Documentation Guide
CPT code 92019 (Lmtd oph exam general anes) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.28, a non-facility practice expense RVU of 0.42, and a malpractice RVU of 0.06, a total non-facility RVU of 1.76 and facility RVU of 1.76. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $59.98, though rates vary from $55.84 to $80.17 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92019, 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 92019 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 92019 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 92019
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.28 | 1.28 |
| Practice Expense RVU | 0.42 | 0.42 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 1.76 | 1.76 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92019
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 | $61.97 | $61.97 | $59.93 - $68.76 | 29 |
| Florida | $60.73 | $60.73 | $59.18 - $62.42 | 3 |
| Georgia | $58.6 | $58.6 | $57.66 - $59.54 | 2 |
| Illinois | $60.29 | $60.29 | $58.69 - $61.75 | 4 |
| Michigan | $58.75 | $58.75 | $57.82 - $59.67 | 2 |
| North Carolina | $57.12 | $57.12 | $57.12 - $57.12 | 1 |
| New York | $63.15 | $63.15 | $57.49 - $65.89 | 5 |
| Ohio | $57.58 | $57.58 | $57.58 - $57.58 | 1 |
| Pennsylvania | $59.03 | $59.03 | $57.53 - $60.52 | 2 |
| Texas | $58.66 | $58.66 | $57.38 - $59.78 | 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 92019
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92019 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 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 |
| 90760 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90765 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90772 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90774 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 92019
What does CPT code 92019 mean? +
CPT code 92019 represents: Lmtd oph exam general anes. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92019? +
The 2026 Medicare national average non-facility payment for CPT 92019 is $59.98. Rates range from $55.84 to $80.17 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92019? +
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 92019? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team