`92250` Fundus photography w/i&r

What 92250 is

CMS fee schedule short descriptor: Fundus photography w/i&r.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 92250 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	0.39	0.70	0.02	1.11	$37.07
Facility (hospital, ASC)	0.39	0.70	0.02	1.11	$37.07

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Adjust for a Medicare locality:

Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.

Medically Unlikely Edit (MUE)

Medicare caps 92250 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: CMS Policy. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 92250? These codes are bundled into it

92250 is a Column 1 code in 8 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`92201`	Opscpy extnd rta draw uni/bi	0 - no modifier bypass	Check pair
`92202`	Opscpy extnd on/mac draw	0 - no modifier bypass	Check pair
`92227`	Img rta detcj/mntr ds staff	0 - no modifier bypass	Check pair
`92229`	Img rta detc/mntr ds poc aly	0 - no modifier bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`99211`	Off/op est may x req phy/qhp	1 - modifier may bypass	Check pair

92250 is bundled into these codes

92250 appears as a Column 2 code in 6 active edits. Reported with one of these Column 1 codes on the same date of service, 92250 is the code that denies.

Column 1 code	Short description	Modifier indicator
`92133`	Cptrzd oph dx img pst sgm on	1	Check pair
`92134`	Cptrz oph dx img pst sgm rta	1	Check pair
`92137`	Cptrz oph img pst sg rta oct	1	Check pair
`92228`	Img rta detc/mntr ds phy/qhp	0	Check pair
`92240`	Icg angiography i&r uni/bi	1	Check pair
`92242`	Fluorescein&icg angiography	1	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.