CPT 92134

Retinal Imaging (OCT of Retina)

CPT 92134 covers optical coherence tomography (OCT) of the retina, a quick scan used to monitor macular degeneration, diabetic eye disease, and other retinal conditions. The scan itself takes only a few seconds, but providers charge an average of $122.17 for it. Medicare pays just $32.73 (a 3.7x markup). This is one of the highest markups in ophthalmology for an automated, technician-run test.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 92134 at a Glance

Average provider charge: $122.17
Medicare physician fee (office): $32.73
Medicare physician fee (hospital): $32.73 + separate facility fee
Typical markup: 3.7x over Medicare rate

Test duration: Under 5 minutes (scan takes seconds)
Test type: Automated retinal imaging
Common use: Macular degeneration, diabetic retinopathy
Beneficiaries (2023): 3.56 million

How the Medicare Rate Is Calculated

Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). Here is the exact math for a 92134 retinal OCT scan:

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Physician time, skill, and judgment	0.31	0.31
Practice Expense RVU	Equipment, staff, supplies	0.65	0.65
Malpractice RVU	Professional liability insurance	0.02	0.02
Total RVU		0.98	0.98
x $33.4009	2026 conversion factor	$32.73	$32.73

Why the office and facility rates are the same: Unlike most procedures, the Practice Expense RVU for 92134 is identical in both settings (0.65). This is because the OCT equipment cost is built into the practice expense regardless of setting. However, hospital-based practices may still add a separate facility fee on top, making the total higher even though the physician payment is the same.

Medicare Rate by State

Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). For a low-RVU test like 92134, the geographic variation is smaller in dollar terms, but the percentage spread is still significant.

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates (Office Setting)

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$27.70	$122.17	4.4x
California (Los Angeles)	$28.45	$122.17	4.3x
New York (Manhattan)	$28.76	$122.17	4.2x
Florida (Fort Lauderdale)	$27.51	$122.17	4.4x
Ohio	$26.50	$122.17	4.6x
Mississippi	$25.73	$122.17	4.7x
Arkansas	$25.63	$122.17	4.8x
Alaska	$30.39	$122.17	4.0x

Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $122.17 is the 2023 national average from CMS utilization data. Actual charges vary by provider.

What Insured Patients Actually Pay for a Retinal OCT

If you have health insurance, you do not pay the provider's full charge of $122.17. Your insurer has a negotiated rate, typically 120% to 200% of Medicare. For a 92134 scan, that negotiated rate is usually $40 to $65. What you owe depends on your plan:

Your Situation	What You Likely Pay	How It Works
Copay plan (deductible met or N/A)	$0 to $30	May be bundled with office visit copay or have a separate diagnostic test copay
Coinsurance plan (deductible met)	$8 to $13	20% of the negotiated rate ($40 to $65)
High-deductible plan (deductible NOT met)	$40 to $65	You pay the full negotiated rate until your deductible is met
Medicare Part B	$6.55	20% of the Medicare-approved amount ($32.73)
Medicaid	$0 to $3	Minimal or no cost-sharing in most states

Medical vs. vision insurance: If you have diabetes or a diagnosed retinal condition, the OCT scan should be billed to your medical insurance, not your vision plan. Vision plans typically cover routine eye exams and corrective lenses, not diagnostic imaging for medical conditions. Billing to the wrong plan can result in a denial and an unexpected out-of-pocket charge.

Should You Use Insurance or Pay Cash?

At $122 average charge, the retinal OCT is not a huge expense on its own. But it adds up when combined with the office visit, a possible optic nerve OCT (92133), and any other tests ordered the same day. If you have a high-deductible plan and have not met your deductible, consider whether the provider offers a cash-pay discount.

When Cash-Pay Wins

Your deductible is high and unlikely to be met this year
The provider offers a cash rate below $50 for the scan
You are seeing an out-of-network ophthalmologist

When Using Insurance Wins

You are close to meeting your deductible for the year
Your plan has a low diagnostic test copay ($10 to $20)
You have Medicare (your cost is only $6.55)
The scan is part of ongoing treatment that needs insurance documentation

Important trade-off: Cash payments do not count toward your insurance deductible or out-of-pocket maximum. If you are monitoring a chronic eye condition and expect multiple visits this year, running everything through insurance may be the smarter long-term strategy even if each individual visit costs more.

Common Billing Problems with 92134

Double OCT charges: 92133 and 92134 at the same visit

Ophthalmologists frequently order both the optic nerve OCT (92133) and the retinal OCT (92134) at the same appointment. Each generates its own charge. While this is legitimate when both areas need monitoring (for example, a patient with both glaucoma and macular degeneration), it can also be routine overbilling. If you only have one of these conditions, ask why both scans were necessary.

OCT ordered at every visit when not clinically necessary

For stable conditions, clinical guidelines suggest OCT monitoring every 6 to 12 months, not at every office visit. Some practices run an OCT at every appointment regardless of clinical need. If you are being billed for OCT scans more than twice a year and your condition is stable, ask your doctor whether the frequency is medically necessary. Insurance may deny the claim, leaving you with the bill.

Billed to vision insurance instead of medical insurance

If you have diabetes, macular degeneration, or another medical eye condition, the OCT should be billed to your medical insurance under a medical diagnosis code. Some offices default to billing vision insurance, which may not cover diagnostic imaging and can result in a full out-of-pocket charge. Verify which insurance plan was billed, especially if you receive a denial or unexpected balance.

The 3.7x markup on a 5-second automated scan

The OCT machine does most of the work. A technician positions you, the machine captures images in seconds, and the doctor reviews the results. The $122 average charge reflects a 3.7x markup over what Medicare considers fair payment. If you are paying out of pocket, use the $32.73 Medicare rate as your negotiation baseline. Many providers will accept $40 to $60 cash for this test.

Related Eye Imaging Codes

Code	Description	Medicare (Office)	Avg. Charge
92133	OCT of optic nerve (glaucoma monitoring)	$32.73	$115.00
92134	OCT of retina (macular imaging)	$32.73	$122.17
92250	Fundus photography (retinal photo)	$37.07	$118.16
92004	Comprehensive eye exam, new patient	$150.56	$310.00
92014	Comprehensive eye exam, established patient	$115.41	$235.00

Frequently Asked Questions

How much does a retinal OCT scan (CPT 92134) cost without insurance?

Without insurance, a retinal OCT scan billed under CPT 92134 costs $80 to $200 depending on the provider and location. The national average charge is $122.17. Medicare pays only $32.73 for this scan, making the average markup 3.7x. If you are paying cash, ask about a self-pay discount. Many offices will accept $40 to $60 for the scan alone.

Is a retinal OCT scan (92134) billed separately from my eye exam?

Yes. The retinal OCT scan is always a separate charge from your eye exam (92004 or 92014). The scan takes only a few seconds, but it generates its own line item. It is also separate from the optic nerve OCT (92133), which your doctor may also order at the same visit. You could see three charges on one bill: the exam, the retinal OCT, and the optic nerve OCT.

Should a diabetic retinal OCT be billed to medical insurance or vision insurance?

If you have diabetes, a retinal OCT scan should be billed to your medical insurance, not your vision plan. Diabetic eye disease monitoring is a medical condition. Vision plans cover routine eye exams and corrective lenses, not diagnostic imaging for medical conditions. Make sure your provider uses a diabetes-related diagnosis code (such as E11.3x for diabetic retinopathy) so your medical insurance processes it correctly.

What is the difference between CPT 92133 and 92134?

CPT 92133 is OCT scanning of the optic nerve, used primarily for glaucoma monitoring. CPT 92134 is OCT scanning of the retina (macula), used for macular degeneration and diabetic retinopathy. Both use the same machine and have similar Medicare rates ($32.73), but they target different parts of the eye. If you see both on your bill, verify that your doctor actually needed both scans for your specific conditions.

Need Help Lowering a Medical Bill?

CareRoute Bill Defense is a done-for-you bill reduction service. We analyze the codes on your bill, identify overcharges and coding errors, and apply negotiation and reduction strategies on your behalf. If you are dealing with a bill that seems too high, we can help.

Learn about Bill Defense