Fundus Photography (Retinal Photography)
CPT 92250 covers fundus photography, the "retinal photo" many eye practices now offer as part of a routine exam. Providers charge an average of $118.16 for this test, while Medicare pays just $37.07 (a 3.2x markup). Many patients do not realize this is a separate charge from their eye exam, and some practices offer it as an alternative to dilation without clearly explaining the cost.
CPT 92250 at a Glance
- Average provider charge: $118.16
- Medicare physician fee (office): $37.07
- Medicare physician fee (hospital): $37.07 + separate facility fee
- Typical markup: 3.2x over Medicare rate
- Test duration: Under 5 minutes
- Test type: Retinal photograph
- Common use: Retinal documentation, screening
- Beneficiaries (2023): 2.89 million
On this page
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 92250 fundus photograph:
| Component | What It Covers | Office (Non-Facility) | Hospital (Facility) |
|---|---|---|---|
| Work RVU | Physician time, skill, and judgment | 0.39 | 0.39 |
| Practice Expense RVU | Equipment, staff, supplies | 0.70 | 0.70 |
| Malpractice RVU | Professional liability insurance | 0.02 | 0.02 |
| Total RVU | 1.11 | 1.11 | |
| x $33.4009 | 2026 conversion factor | $37.07 | $37.07 |
Medicare Rate by State
Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). For 92250, the geographic variation is modest in dollar terms because the base rate is low, but markups relative to Medicare are dramatic across the board.
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) | $31.38 | $118.16 | 3.8x |
| California (Los Angeles) | $32.27 | $118.16 | 3.7x |
| New York (Manhattan) | $32.65 | $118.16 | 3.6x |
| Florida (Fort Lauderdale) | $31.14 | $118.16 | 3.8x |
| Ohio | $29.93 | $118.16 | 3.9x |
| Mississippi | $29.06 | $118.16 | 4.1x |
| Arkansas | $28.93 | $118.16 | 4.1x |
| Alaska | $34.57 | $118.16 | 3.4x |
Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $118.16 is the 2023 national average from CMS utilization data. Actual charges vary by provider.
What Insured Patients Actually Pay for Fundus Photography
If you have health insurance, you do not pay the full $118.16 charge. Your insurer negotiates a rate, typically 120% to 200% of Medicare. For a 92250 retinal photo, that negotiated rate is usually $44 to $74. Your share depends on your plan design:
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| Copay plan (deductible met or N/A) | $0 to $30 | May be bundled with your office visit copay or have a separate diagnostic copay |
| Coinsurance plan (deductible met) | $9 to $15 | 20% of the negotiated rate ($44 to $74) |
| High-deductible plan (deductible NOT met) | $44 to $74 | You pay the full negotiated rate until your deductible is met |
| Medicare Part B | $7.41 | 20% of the Medicare-approved amount ($37.07) |
| Medicaid | $0 to $3 | Minimal or no cost-sharing in most states |
Should You Use Insurance or Pay Cash?
Many optometrists offer retinal screening photos for $30 to $50 as a cash service, which can be cheaper than running it through insurance (especially if your deductible is not met). If the test is being used for screening rather than to diagnose a specific condition, paying cash may also help you avoid a claim denial on your record.
When Cash-Pay Wins
- The test is for routine screening, not a diagnosed condition
- Your provider offers a cash rate of $30 to $50
- Your deductible is high and unlikely to be met this year
- You want to avoid a potential claim denial for a "screening" test
When Using Insurance Wins
- You have a diagnosed eye condition (diabetic retinopathy, macular degeneration)
- You are close to meeting your annual deductible
- Your plan has a low diagnostic test copay
- You have Medicare (your cost is only about $7)
Common Billing Problems with 92250
Charged for retinal photo AND dilation at the same visit
Some practices offer retinal photography as a "no-dilation" alternative, then also perform dilation at the same visit and charge for both. If the photo was presented as a substitute for dilation, you should not be paying for both services. Review your bill for a retinal photo charge alongside a comprehensive dilated exam code (92004 or 92014). If both appear, ask the office to justify the charges.
Insurance denial for "screening" fundus photo
If your provider bills 92250 without a specific medical diagnosis code, insurance may deny it as a screening test. This can leave you responsible for the full charge. Before agreeing to a retinal photo, ask whether your provider will bill it with a diagnostic code that supports medical necessity. If you receive a denial, ask the office to resubmit with an appropriate diagnosis.
Optometrist cash photo is the same test billed differently
The $30 to $50 "retinal screening photo" offered by many optometrists is typically the same service as CPT 92250. When billed through insurance, the same photo can cost $118 on average. If you are paying cash, there is no reason to pay the insurance-billed price. Ask for the cash or self-pay rate, which should be comparable to what optometrists charge for walk-in retinal photos.
Routine ordering without clinical indication
Some practices order fundus photography at every visit, regardless of whether it is clinically needed. If you have no diagnosed eye condition and the photo is being done "for your records," question whether it is necessary. Healthy patients without risk factors may not need retinal photos at every annual exam. The test is valuable for monitoring changes over time in patients with known conditions, but it is not universally recommended for low-risk patients.
Related Eye Imaging Codes
| Code | Description | Medicare (Office) | Avg. Charge |
|---|---|---|---|
| 92134 | OCT of retina (macular imaging) | $32.73 | $122.17 |
| 92250 | Fundus photography (retinal photo) | $37.07 | $118.16 |
| 92133 | OCT of optic nerve (glaucoma monitoring) | $32.73 | $115.00 |
| 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 fundus photography (CPT 92250) cost without insurance?
Without insurance, fundus photography costs $60 to $180 depending on the provider. The national average charge is $118.16, while Medicare pays only $37.07 (a 3.2x markup). Many optometrists offer retinal screening photos for $30 to $50 cash, which may be the same test. If paying out of pocket, ask about the self-pay rate before the test is performed.
Is fundus photography the same as the retinal photo offered instead of dilation?
Often yes. Many eye practices offer a "retinal screening photo" as a convenience alternative to dilation drops. This is frequently the same test billed as CPT 92250. However, a retinal photo is not a complete substitute for a dilated exam in all cases. If your provider performed both the photo and dilation, check your bill. You may be paying for a convenience service that was ultimately supplemented by the standard exam anyway.
Does insurance cover fundus photography (92250)?
Insurance typically covers 92250 when it is medically necessary, meaning your doctor ordered it to diagnose or monitor a specific eye condition like diabetic retinopathy, macular degeneration, or glaucoma. If the photo is used for routine screening without a specific diagnosis, insurance may deny the claim. Ask your provider before the test whether it will be billed as diagnostic or screening.
Can I be charged for fundus photography on top of a dilated eye exam?
Yes. Fundus photography and a dilated eye exam are considered separate services, so providers can bill both at the same visit. However, if the retinal photo was offered as a substitute for dilation and then both were performed, you may have grounds to question the duplicate charge. Review your bill carefully and ask the practice to justify both charges if this situation applies.
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