The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full North Carolina vision schedule has 47 codes.
- Every code on all 51 published schedules
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Published codes
47
Vision procedures on the 2026 schedule
Median % of Medicare
68.5%
vs national Medicare, GPCI-neutral
Effective vintage
2026
latest effective year on the schedule
Common vision procedures and what North Carolina Medicaid pays
A curated sample of recognizable procedures from the 47-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 | North Carolina rate | % of Medicare |
|---|---|---|---|
| 92002 | Eye exam, new patient, intermediate | $53.85 | 63.5% |
| 92004 | Eye exam, new patient, comprehensive | $101.69 | 68% |
| 92012 | Eye exam, established patient, intermediate | $56.74 | 62.7% |
| 92014 | Eye exam, established patient, comprehensive | $82.96 | 65.2% |
| 92015 | Determination of eyeglass prescription (refraction) | $25.11 | -- |
| 92083 | Visual field examination, extended | $57.19 | 89.7% |
| 92134 | Retinal imaging (OCT scan) | $35.88 | 109.6% |
| 92250 | Photography of the back of the eye (fundus) | $60.00 | 161.9% |
| 92273 | Full-field electroretinography (ERG) | $110.40 | 89.6% |
| 92283 | Color vision examination, extended | $32.39 | 58.8% |
| 92340 | Fitting of eyeglasses, single vision | $9.92 | -- |
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 North Carolina Medicaid fee schedules
- North Carolina physician fee schedule · 6,547 codes
- North Carolina lab & imaging fee schedule · 1,935 codes
- North Carolina dme & supplies fee schedule · 1,051 codes
- North Carolina drugs fee schedule · 369 codes
- North Carolina other services fee schedule · 91 codes
- North Carolina behavioral health fee schedule · 24 codes
Vision rates in neighboring states
Frequently asked questions
What does North Carolina Medicaid pay for vision services and eyewear?
North Carolina Medicaid publishes 47 vision procedure rates effective 2026, paying a median 68.5% 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 North Carolina's vision rates compare with Medicare?
Across vision codes with a national Medicare comparator, North Carolina Medicaid pays a median 68.5% 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 North Carolina?
North Carolina 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 North Carolina'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 North Carolina changes these rates.