The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full New Jersey vision schedule has 136 codes.
- Every code on all 51 published schedules
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Published codes
136
Vision procedures on the 2026 schedule
Median % of Medicare
74.5%
vs national Medicare, GPCI-neutral
PA required
39
codes flagged by the state
Common vision procedures and what New Jersey Medicaid pays
A curated sample of recognizable procedures from the 136-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 | New Jersey rate | % of Medicare |
|---|---|---|---|
| 92002 | Eye exam, new patient, intermediate | $61.33 | 72.3% |
| 92004 | Eye exam, new patient, comprehensive | $111.66 | 74.6% |
| 92012 | Eye exam, established patient, intermediate | $56.72 | 62.7% |
| 92014 | Eye exam, established patient, comprehensive | $83.50 | 65.6% |
| 92015 | Determination of eyeglass prescription (refraction) | $38.50 | -- |
| 92083 | Visual field examination, extended | $64.91 | 101.8% |
| 92134 | Retinal imaging (OCT scan) | $16.73 | 51.1% |
| 92250 | Photography of the back of the eye (fundus) | $53.49 | 144.3% |
| 92273 | Full-field electroretinography (ERG) | $63.38 | 51.4% |
| V2020 | Frames, purchases | $53.73 | 60.7% |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | $44.77 | 82.2% |
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 New Jersey Medicaid fee schedules
- New Jersey physician fee schedule · 6,804 codes
- New Jersey lab & imaging fee schedule · 2,234 codes
- New Jersey dme & supplies fee schedule · 1,751 codes
- New Jersey drugs fee schedule · 953 codes
- New Jersey other services fee schedule · 209 codes
- New Jersey behavioral health fee schedule · 46 codes
Vision rates in neighboring states
Frequently asked questions
What does New Jersey Medicaid pay for vision services and eyewear?
New Jersey Medicaid publishes 136 vision procedure rates effective 2026, paying a median 74.5% 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 New Jersey's vision rates compare with Medicare?
Across vision codes with a national Medicare comparator, New Jersey Medicaid pays a median 74.5% 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 New Jersey?
New Jersey publishes prior-authorization flags on its schedule: 39 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 New Jersey'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 New Jersey changes these rates.