The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full District of Columbia vision schedule has 160 codes.
- Every code on all 51 published schedules
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Published codes
160
Vision procedures on the 2026 schedule
Median % of Medicare
90.5%
vs national Medicare, GPCI-neutral
PA required
96
+4 conditional or varies
Common vision procedures and what District of Columbia Medicaid pays
A curated sample of recognizable procedures from the 160-code schedule. Rates are the state's published fee-for-service amounts; the percentage compares each rate with the national Medicare amount for the same code.
| Code | Procedure | District of Columbia rate | % of Medicare |
|---|---|---|---|
| 92002 | Eye exam, new patient, intermediate | $77.00 | 90.8% |
| 92004 | Eye exam, new patient, comprehensive | $134.92 | 90.2% |
| 92012 | Eye exam, established patient, intermediate | $82.20 | 90.8% |
| 92014 | Eye exam, established patient, comprehensive | $115.15 | 90.5% |
| 92015 | Determination of eyeglass prescription (refraction) | $16.68 | -- |
| 92083 | Visual field examination, extended | $58.46 | 91.6% |
| 92134 | Retinal imaging (OCT scan) | $29.78 | 91% |
| 92250 | Photography of the back of the eye (fundus) | $33.62 | 90.7% |
| 92273 | Full-field electroretinography (ERG) | $113.88 | 92.4% |
| 92283 | Color vision examination, extended | $51.34 | 93.2% |
| 92340 | Fitting of eyeglasses, single vision | $32.46 | -- |
| V2020 | Frames, purchases | $61.41 | 69.4% |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | $47.14 | 86.5% |
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 * show the schedule's representative published variant.
More District of Columbia Medicaid fee schedules
- District of Columbia physician fee schedule · 6,530 codes
- District of Columbia lab & imaging fee schedule · 1,998 codes
- District of Columbia dme & supplies fee schedule · 1,711 codes
- District of Columbia drugs fee schedule · 868 codes
- District of Columbia other services fee schedule · 454 codes
- District of Columbia behavioral health fee schedule · 68 codes
Vision rates in neighboring states
Frequently asked questions
What does District of Columbia Medicaid pay for vision services and eyewear?
District of Columbia Medicaid publishes 160 vision procedure rates effective 2026, paying a median 90.5% of the national Medicare amount for the same services. The schedule covers eye exams, refractions, frames, and lenses. The table on this page shows published rates for common procedures; the complete all-codes schedule is available as a CSV download with a ProviderSignal Rates subscription.
How do District of Columbia's vision rates compare with Medicare?
Across vision codes with a national Medicare comparator, District of Columbia Medicaid pays a median 90.5% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.
Do vision services need prior authorization in District of Columbia?
District of Columbia publishes prior-authorization flags on its schedule: 96 vision codes are marked as always requiring PA. Codes without a flag carry no published PA indicator.
Where do these rates come from?
Directly from District of Columbia's published Medicaid fee-for-service schedule (effective 2026), collected and normalized by ProviderSignal across all 50 states + DC. Rates are re-collected on a rolling schedule and this page updates automatically. Procedure descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.
Get an email the next time District of Columbia changes these rates.