Reddenda · Rate Intelligence · National

92004: Eye exam, new patient, comprehensive

What commercial payers pay · observed distribution across payer filings · 2,197,657 rate observations

• The national median commercial rate observed for CPT 92004 (Eye exam, new patient, comprehensive) is $124.39, from 2,197,657 published rate records across payers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels payers to publish these rates
• The observed spread runs from a 25th percentile of $93.63 to a 90th percentile of $282.95: a 202% difference between the low and high of the distribution for the same code.Source: 45 CFR §147.212 (Transparency in Coverage)
• Medicare's national non-facility rate for CPT 92004 is $149.64, so the observed commercial median of $124.39 is about 83% of Medicare.Source: CMS Medicare Physician Fee Schedule
• This is a national distribution across payers, not a local or payer-specific benchmark. What a specific provider is actually paid depends on its own contracts and local market; a RateScore measures that against local peers.Source: Reddenda methodology
• A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this code.Source: 45 CFR §149.510(c)(4)(iii)(B) (No Surprises Act IDR)

Observed distribution across payer filings nationally, modeled from public rates and never guaranteed. This is not a local peer median or a RateScore: those measure a specific provider against its local peers and its own payers. Basis: CMS-descriptor CPT 92004 across indexed commercial payer files. Federal citation for the underlying obligation: 45 CFR §147.212. As of 2026-07-24; page generated 2026-07-24 17:50 UTC.