CPT 92228
Global XXX ActiveImg rta detc/mntr ds phy/qhp
CPT 92228 Billing & Documentation Guide
CPT code 92228 (Img rta detc/mntr ds phy/qhp) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.31, a non-facility practice expense RVU of 0.58, and a malpractice RVU of 0.02, a total non-facility RVU of 0.91 and facility RVU of 0.91. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $31.36, though rates vary from $27.34 to $39.79 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92228, 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 92228 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 92228 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 92228
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.31 | 0.31 |
| Practice Expense RVU | 0.58 | 0.58 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 0.91 | 0.91 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92228
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 | $34.01 | $34.01 | $32.12 - $39.79 | 29 |
| Florida | $31.09 | $31.09 | $29.88 - $32.21 | 3 |
| Georgia | $29.65 | $29.65 | $28.43 - $30.87 | 2 |
| Illinois | $30.39 | $30.39 | $29.09 - $31.51 | 4 |
| Michigan | $29.49 | $29.49 | $28.8 - $30.18 | 2 |
| North Carolina | $28.86 | $28.86 | $28.86 - $28.86 | 1 |
| New York | $33.37 | $33.37 | $29.23 - $35.29 | 5 |
| Ohio | $28.71 | $28.71 | $28.71 - $28.71 | 1 |
| Pennsylvania | $30.13 | $30.13 | $28.77 - $31.5 | 2 |
| Texas | $30.1 | $30.1 | $28.6 - $31.46 | 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 92228
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92228 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0604T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0605T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0606T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 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 |
| 92133 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92134 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92227 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92229 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92250 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 92228
What does CPT code 92228 mean? +
CPT code 92228 represents: Img rta detc/mntr ds phy/qhp. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92228? +
The 2026 Medicare national average non-facility payment for CPT 92228 is $31.36. Rates range from $27.34 to $39.79 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92228? +
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 92228? +
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