CPT 92004 Ophthalmology

How Much Does Compre Oph Examination New Patient Patient 1 or More Cost?

Also known as: Compre oph exam new pt 1/> (CPT 92004)

A comprehensive eye exam including dilation, performed by an ophthalmologist.

Compre Oph Examination New Patient Patient 1 or More (CPT 92004) costs $78 at Medicare rates.

Medicare (Facility)
$78
CMS PFS 2026 national rate
Medicare Physician Fee (Office/Clinic)
$150
Non-facility setting

Patient Guide: Compre Oph Examination New Patient Patient 1 or More

What you need to know before your appointment

What to Expect

The doctor will test your vision, check eye pressure, examine the front and back of your eyes, and dilate your pupils with drops to examine the retina. Dilation causes temporary blurry vision and light sensitivity.

How Long Does It Take?

30-60 minutes

Common Reasons Doctors Order This

Annual eye exam, diabetes eye screening, glaucoma evaluation, eye disease monitoring, new eye symptoms

How to Prepare

Bring sunglasses for after dilation. Arrange a driver if you are sensitive to the dilation. Bring your current glasses or contacts. Bring a list of medications.

Procedures Commonly Done Together

These procedures are frequently performed alongside Compre oph exam new pt 1/>

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How to Reduce Your Cost for Compre oph exam new pt 1/>

Practical tips that can save you hundreds or thousands of dollars

  • 1
    Ask about cash-pay discounts

    Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.

  • 2
    Compare facility vs. office setting costs

    For this procedure, the office rate ($150) differs from the facility rate ($78). Ask if it can be done in an office setting.

  • 3
    Shop around — costs vary significantly

    Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.

How is the Price Calculated?

Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.

1.82
Work RVU
0.47
Practice Expense RVU
0.04
Malpractice RVU
4.48
Total RVU

Payment = Total RVU (4.48) x CF ($33.40) = $150

People Also Ask

Common questions people search for about this procedure

Do all eye exams check for glaucoma?

If you are younger than 40 and have no known risk factors for glaucoma, the American Academy of Ophthalmology (AAO) recommends a complete eye exam every 5 to 10 years. The exam includes tests that check for glaucoma. The recommended schedule for those over 40 are: Every 1-2 years for adults 40-54.

How much is an eye exam without insurance in the USA?

On average, you can expect to pay 0 to 00 for an eye exam without insurance. You can call ahead for a rough estimate to help you budget accordingly.

Source: www.pearlevision.com See our data-backed answer →
How much does an eye exam at Walmart cost?

A comprehensive eye health and vision exam starts at 5.00. A basic contact lens exam starts at 10.00. If you have astigmatism or need bifocal correction and want to wear contact lenses, there is a modest additional cost. Q.

Source: www.rucnokvisioncare.com See our data-backed answer →
Do you get a free eye test with glaucoma?

You're eligible for a free NHS sight test if: you've been diagnosed with diabetes or glaucoma. you're aged 40 or over and your mother, father, sibling or child has been diagnosed with glaucoma. you've been told by an ophthalmologist you're at risk of glaucoma.

Source: faq.nhsbsa.nhs.uk See our data-backed answer →

Frequently Asked Questions

How much does Compre oph exam new pt 1/> cost?

The Medicare facility rate for Compre oph exam new pt 1/> is $78. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).

How much does Compre oph exam new pt 1/> cost without insurance?

Without insurance, the cost of Compre oph exam new pt 1/> can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.

Does insurance cover Compre oph exam new pt 1/>?

Most commercial health insurance plans and Medicare cover Compre oph exam new pt 1/> when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.

Why does the cost vary so much by location?

Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.

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