CPT 92201
Global XXX ActiveOpscpy extnd rta draw uni/bi
CPT 92201 Billing & Documentation Guide
CPT code 92201 (Opscpy extnd rta draw uni/bi) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.39, a non-facility practice expense RVU of 0.34, and a malpractice RVU of 0.02, a total non-facility RVU of 0.75 and facility RVU of 0.55. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $25.72, though rates vary from $23.13 to $32 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92201, 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 92201 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 92201 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 92201
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.39 | 0.39 |
| Practice Expense RVU | 0.34 | 0.14 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 0.75 | 0.55 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92201
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 | $27.29 | $19.39 | $26.05 - $31.19 | 29 |
| Florida | $25.72 | $19.02 | $24.89 - $26.54 | 3 |
| Georgia | $24.68 | $18.31 | $23.95 - $25.41 | 2 |
| Illinois | $25.32 | $18.87 | $24.44 - $26.06 | 4 |
| Michigan | $24.63 | $18.36 | $24.15 - $25.11 | 2 |
| North Carolina | $24.05 | $17.82 | $24.05 - $24.05 | 1 |
| New York | $27.22 | $19.77 | $24.28 - $28.6 | 5 |
| Ohio | $24.07 | $17.97 | $24.07 - $24.07 | 1 |
| Pennsylvania | $24.98 | $18.44 | $24.08 - $25.88 | 2 |
| Texas | $24.9 | $18.32 | $23.98 - $25.66 | 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 92201
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92201 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 92202 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 99211 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 99211 | Column 1 (primary), can be billed with modifier | 9 | Misuse of Column Two code with Column One code |
| 0465T | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
| 67005 | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
| 67010 | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
| 67015 | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 92201
What does CPT code 92201 mean? +
CPT code 92201 represents: Opscpy extnd rta draw uni/bi. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92201? +
The 2026 Medicare national average non-facility payment for CPT 92201 is $25.72. Rates range from $23.13 to $32 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92201? +
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 92201? +
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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