#141 of 11K

92004

Ophthalmological exam, comprehensive, new patient

Ophthalmological exam, comprehensive, new patient is the #141 most-billed Medicaid procedure code, with $1.30B in payments across 20.6M claims from 2018–2024. The national median cost per claim is $59.72.

Total Paid

$1.30B

0.12% of all spending

Total Claims

20.6M

Providers

22K

Avg Cost/Claim

$63

National Cost Distribution

How much do providers bill per claim for 92004? Based on 21K providers billing this code nationally.

Median

$59.72

Average

$64.70

Std Dev

$40.18

Max

$740.62

Percentile Distribution (Cost per Claim)

p10

$23.90

p25

$40.22

Median

$59.72

p75

$86.25

p90

$111.61

p95

$123.31

p99

$159.13

50% of providers bill between $40.22 and $86.25 per claim for this code.

90% bill between $23.90 and $111.61.

Top 1% bill above $159.13.

About This Procedure

HCPCS code 92004 (Ophthalmological exam, comprehensive, new patient) was billed by 22K providers across 20.6M claims, totaling $1.30B in Medicaid payments from 2018–2024. This code was used for 19.7M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$59.72

Providers Billing

21K

National Spending

$1.30B

Avg/Median Ratio

1.08×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 92004

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1942644661	$19.3M	$69.85	1.2× median	Above Median
2	Premier Eye Care Of Florida Llc Coral Gables, FL · Exclusive Provider Organization	$15.6M	$88.32	1.5× median	Above 75th
3	1083660815	$5.9M	$633.40	10.6× median	Top 1%
4	Phoenix Children's Hospital Phoenix, AZ · Pediatrics	$5.6M	$149.36	2.5× median	Top 10%
5	1326472945	$5.3M	$31.86	0.5× median	Below Median
6	1104868520	$5.3M	$88.94	1.5× median	Above 75th
7	Mid Atlantic Pemanente Medical Group Rockville, MD · Health Maintenance Organization	$5.3M	$149.94	2.5× median	Top 10%
8	1417261215	$3.9M	$89.04	1.5× median	Above 75th
9	1487077483	$3.2M	$116.21	1.9× median	Top 10%
10	1316146574	$3.0M	$125.50	2.1× median	Top 10%
11	1023063187	$2.7M	$101.48	1.7× median	Above 75th
12	Park Nicollet Clinic St Louis Park, MN · Obstetrics & Gynecology	$2.7M	$94.12	1.6× median	Above 75th
13	Group Health Plan, Inc. Minneapolis, MN · Clinic/Center, Multi-Specialty	$2.7M	$91.07	1.5× median	Above 75th
14	1033161195	$2.7M	$103.61	1.7× median	Above 75th
15	1487655965	$2.6M	$84.94	1.4× median	Above Median
16	1356860811	$2.6M	$66.54	1.1× median	Above Median
17	1265429658	$2.3M	$110.33	1.8× median	Above 75th
18	1376574707	$2.3M	$109.75	1.8× median	Above 75th
19	1700075843	$2.2M	$130.15	2.2× median	Top 10%
20	1487704581	$2.2M	$106.57	1.8× median	Above 75th

Showing top 20 of 22K providers billing this code

Related Procedures

92014Ophthalmological exam, comprehensive, established patient$1.86B 92012Ophthalmological exam, intermediate, established patient$435.8M 92002Intermediate eye exam, new patient$52.2M

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