The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full Illinois vision schedule has 82 codes.
- Every code on all 51 published schedules
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Published codes
82
Vision procedures on the 2026 schedule
Median % of Medicare
30.9%
vs national Medicare, GPCI-neutral
Effective vintage
2026
latest effective year on the schedule
Common vision procedures and what Illinois Medicaid pays
A curated sample of recognizable procedures from the 82-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 | Illinois rate | % of Medicare |
|---|---|---|---|
| 92002 | Eye exam, new patient, intermediate | $29.19 | 34.4% |
| 92004 | Eye exam, new patient, comprehensive | $60.43 | 40.4% |
| 92012 | Eye exam, established patient, intermediate | $32.23 | 35.6% |
| 92014 | Eye exam, established patient, comprehensive | $48.56 | 38.2% |
| 92015 | Determination of eyeglass prescription (refraction) | $24.24 | -- |
| 92083 | Visual field examination, extended | $39.83 | 62.4% |
| 92134 | Retinal imaging (OCT scan) | $25.71 | 78.6% |
| 92250 | Photography of the back of the eye (fundus) | $33.68 | 90.9% |
| 92273 | Full-field electroretinography (ERG) | $78.55 | 63.7% |
| 92283 | Color vision examination, extended | $33.69 | 61.1% |
| 92340 | Fitting of eyeglasses, single vision | $40.59 | -- |
| V2020 | Frames, purchases | $9.36 | 10.6% |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | $6.39 | 11.7% |
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 Illinois Medicaid fee schedules
- Illinois physician fee schedule · 6,469 codes
- Illinois lab & imaging fee schedule · 2,095 codes
- Illinois dme & supplies fee schedule · 1,563 codes
- Illinois drugs fee schedule · 782 codes
- Illinois other services fee schedule · 185 codes
- Illinois hearing fee schedule · 45 codes
Vision rates in neighboring states
Frequently asked questions
What does Illinois Medicaid pay for vision services and eyewear?
Illinois Medicaid publishes 82 vision procedure rates effective 2026, paying a median 30.9% 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 Illinois's vision rates compare with Medicare?
Across vision codes with a national Medicare comparator, Illinois Medicaid pays a median 30.9% 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 Illinois?
Illinois does not publish prior-authorization indicators on this fee schedule, so PA requirements must be confirmed through the state's provider manual or portal. Absence of a flag here means "not published", never "no PA required".
Where do these rates come from?
Directly from Illinois'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 Illinois changes these rates.