The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 92242. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
45
Median % of Medicare
66.7%
Rate range
$126.13 - $516.69
92242 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $516.69 | 153.6% | -- | 2026 |
| Arkansas | $252.06 | 74.9% | -- | 2026 |
| Arizona | $331.24 | 98.5% | -- | 2025 |
| California | $207.76 | 61.8% | -- | 2026 |
| Colorado | $226.18 | 67.2% | -- | 2026 |
| Connecticut | $204.63 | 60.8% | -- | 2026 |
| District of Columbia | $313.82 | 93.3% | Not required | 2026 |
| Delaware | $326.07 | 96.9% | -- | 2026 |
| Georgia | $194.60 | 57.9% | -- | 2026 |
| Hawaii | $316.93 | 94.2% | -- | 2025 |
| Iowa | $174.96 | 52% | -- | 2024 |
| Idaho | $268.99 | 80% | Not required | 2026 |
| Illinois | $173.74 | 51.7% | -- | 2024 |
| Indiana | $291.72 | 86.7% | -- | 2026 |
| Kentucky | $169.78 | 50.5% | -- | 2026 |
| Louisiana | $213.45 | 63.5% | -- | 2026 |
| Massachusetts | $204.25 | 60.7% | -- | 2026 |
| Maine | $225.55 | 67.1% | -- | 2026 |
| Michigan | $214.49 | 63.8% | -- | 2026 |
| Minnesota | $265.01 | 78.8% | -- | 2026 |
| Missouri | $187.43 | 55.7% | Not required | 2022 |
| Mississippi | $190.11 | 56.5% | -- | 2020 |
| Montana | $441.34 | 131.2% | -- | 2026 |
| North Carolina | $185.74 | 55.2% | -- | 2025 |
| North Dakota | $377.37 | 112.2% | Not required | 2026 |
| Nebraska | $126.13 | 37.5% | -- | 2026 |
| New Hampshire | $149.63 | 44.5% | Not required | 2026 |
| New Jersey | $173.70 | 51.6% | Not required | 2026 |
| New Mexico | $380.77 | 113.2% | -- | 2025 |
| Nevada | $210.58 | 62.6% | -- | 2024 |
| New York | $224.46 | 66.7% | -- | 2026 |
| Ohio | $196.64 | 58.5% | -- | 2024 |
| Oklahoma | $283.67 | 84.3% | -- | 2026 |
| Oregon | $274.18* | 81.5% | -- | 2026 |
| Pennsylvania | $262.43 | 78% | -- | 2017 |
| Rhode Island | $315.42 | -- | -- | 2026 |
| South Carolina | $180.79 | 53.8% | -- | 2024 |
| Texas | $138.94* | 41.3% | -- | 2025 |
| Utah | $249.61* | 74.2% | Not required | 2026 |
| Virginia | $291.38 | 86.6% | -- | 2026 |
| Vermont | $284.52 | 84.6% | -- | 2026 |
| Washington | $210.78 | 62.7% | -- | 2026 |
| Wisconsin | $176.44 | 52.5% | -- | 2017 |
| West Virginia | $216.67 | 64.4% | -- | 2026 |
| Wyoming | $282.69 | 84% | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related vision codes
- 92002 - Eye exam, new patient, intermediate
- 92004 - Eye exam, new patient, comprehensive
- 92012 - Eye exam, established patient, intermediate
- 92014 - Eye exam, established patient, comprehensive
- 92015 - Determination of eyeglass prescription (refraction)
- 92018 - Eye exam under general anesthesia, complete
- 92019 - Eye exam under general anesthesia, limited
- 92020 - Gonioscopy (eye drainage angle exam)
Frequently asked questions
How much does Medicaid pay for 92242?
45 state Medicaid programs publish a fee-for-service rate for 92242 (retina dye photography, fluorescein and indocyanine green), ranging from $126.13 in Nebraska to $516.69 in Alaska, with a median of 66.7% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 92242?
Alaska publishes the highest Medicaid rate for 92242 at $516.69 (153.6% of the national Medicare amount). Nebraska publishes the lowest at $126.13.
Does 92242 require prior authorization under Medicaid?
No publishing state flags 92242 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.