The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full Texas vision schedule has 143 codes.
- Every code on all 51 published schedules
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Published codes
143
Vision procedures on the 2025 schedule
Median % of Medicare
49.7%
vs national Medicare, GPCI-neutral
Effective vintage
2025
latest effective year on the schedule
Common vision procedures and what Texas Medicaid pays
A curated sample of recognizable procedures from the 143-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 | Texas rate | % of Medicare |
|---|---|---|---|
| 92002 | Eye exam, new patient, intermediate | $67.90* | 80% |
| 92004 | Eye exam, new patient, comprehensive | $119.22* | 79.7% |
| 92012 | Eye exam, established patient, intermediate | $71.37* | 78.9% |
| 92014 | Eye exam, established patient, comprehensive | $100.77* | 79.2% |
| 92015 | Determination of eyeglass prescription (refraction) | $15.50* | -- |
| 92083 | Visual field examination, extended | $52.39* | 82.1% |
| 92134 | Retinal imaging (OCT scan) | $13.63* | 41.6% |
| 92250 | Photography of the back of the eye (fundus) | $45.71* | 123.3% |
| 92273 | Full-field electroretinography (ERG) | $101.04* | 82% |
| V2020 | Frames, purchases | $38.46* | 43.5% |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | $27.46* | 50.4% |
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 Texas Medicaid fee schedules
- Texas physician fee schedule · 6,550 codes
- Texas lab & imaging fee schedule · 2,128 codes
- Texas dme & supplies fee schedule · 1,910 codes
- Texas drugs fee schedule · 834 codes
- Texas other services fee schedule · 345 codes
- Texas behavioral health fee schedule · 31 codes
Vision rates in neighboring states
Frequently asked questions
What does Texas Medicaid pay for vision services and eyewear?
Texas Medicaid publishes 143 vision procedure rates effective 2025, paying a median 49.7% 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 Texas's vision rates compare with Medicare?
Across vision codes with a national Medicare comparator, Texas Medicaid pays a median 49.7% 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 Texas?
Texas 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 Texas's published Medicaid fee-for-service schedule (effective 2025), 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 Texas changes these rates.