CPT CODEOphthalmologyStatus A

CPT Code 92145Complete Billing & Coding Guide (2026)Corneal hysteresis deter

Reviewed by AAPC-Certified Coders2026 Medicare Fee ScheduleCMS + AMA Sources
Medicare Payment
$14
Non-facility · National avg
Facility
$14
Total RVU
0.41
Global
XXX
Payment
$14
non-facility
Work RVU
0.10
physician effort
Global Period
XXX
no post-op
Bundling Edits
4
NCCI pairs

About CPT 92145

CPT 92145 is a Current Procedural Terminology code in the Ophthalmology category maintained by the American Medical Association. The CMS short descriptor reads "Corneal hysteresis deter". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.

Documentation specificity, correct ICD-10 linkage, and modifier accuracy determine whether 92145 pays cleanly or triggers a denial. Verify CMS National Physician Fee Schedule status, applicable Medicare LCDs, and any payer-specific medical policies before submission.

Pro Tip

92145 has 4 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.

Code Properties

Global Period
XXX
Not applicable (E/M, diagnostic, etc.)
Status Indicator
A
Active. Payment under Medicare PFS.
Conversion Factor
$33.4009
CMS national rate
Effective Date
2026-04-01
per CMS publication

RVU Breakdown

Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.

RVU Composition
0.41 total RVU
0.10
0.29
Work RVU
0.10 · 24%
Physician time + skill
Practice Expense
0.29 · 71%
Office & equipment
Malpractice
0.02 · 5%
Liability insurance
Non-Facility
Private office · urgent care · ambulatory
Most billed
$13.69
0.41 RVU × $33.4009 CF
Facility
Hospital · ASC · nursing home
$13.69
0.41 RVU × $33.4009 CF

Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.

Medicare Payment by State

Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.

AK
$16
DC
$16
CA
$15
NY
$15
NJ
$15
WA
$15
MA
$15
HI
$15
CT
$15
FL
$14
CO
$14
MD
$14

Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.

NCCI Bundling Edits

4 pairs

These codes trigger National Correct Coding Initiative edits when billed with 92145. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.

Common Denial Risk

Billing 92145 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.

AR Recovery Note

Bundling denials on 92145 are recoverable when the edit indicator is 1 and the chart documents a distinct, separately identifiable service. Our coders verify the indicator and pick the precise X-modifier (XE, XS, XP, XU) instead of defaulting to modifier 59.

Applicable Modifiers

Modifiers commonly paired with 92145 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.

33
Preventive services — when the primary purpose is delivery of an evidence-based service per USPSTF A or B recommendation
When to use · Screening services (colonoscopy, mammography, etc.) to indicate the primary purpose is preventive. Waives cost-sharing under ACA.
GA
Waiver of liability statement issued as required by payer policy (ABN on file)
When to use · Medicare: when an Advance Beneficiary Notice (ABN) has been signed by the patient for services that may not be covered.
GY
Item or service statutorily excluded or does not meet the definition of any Medicare benefit
When to use · Service is never covered by Medicare (e.g., cosmetic procedures). May bill patient directly.
GZ
Item or service expected to be denied as not reasonable and necessary — no ABN on file
When to use · When a service is expected to be denied by Medicare and no ABN was obtained. Provider cannot bill the patient.
KX
Requirements specified in the medical policy have been met
When to use · Attestation that LCD/NCD criteria have been met. Common with therapy cap exceptions and DME.
AR Recovery Note

Modifier audits catch what scrubbers miss. Our AAPC-certified team reviews every modifier choice on 92145 against the chart documentation before submission, surfacing missed and misapplied modifiers across the practice.

Supporting ICD-10 Diagnoses

These diagnosis codes commonly support medical necessity for CPT 92145. Using the correct ICD-10 prevents CARC 50 denials. Payer rejects when the diagnosis doesn’t support the procedure.

AR Recovery Note

CARC 50 medical-necessity denials carry both rework cost and an audit-risk signal when patterns repeat. Our coders verify ICD-10 specificity and policy alignment at the coding stage so these losses get prevented upstream.

Free 90-Day AR Recovery Audit

Find the revenue leakage in your 92145 claims.

Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Ophthalmology claims. Our AAPC-certified team audits your last 90 days of 92145 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.

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FAQ

Everything about CPT 92145

What does CPT code 92145 cover?

CPT 92145 is a Current Procedural Terminology code in the Ophthalmology category maintained by the American Medical Association. The CMS short descriptor reads "Corneal hysteresis deter". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.

What is the Medicare payment for CPT 92145?

The national average Medicare payment for CPT 92145 is approximately $13.69 in a non-facility setting and $13.69 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 0.41 with a conversion factor of $33.4009.

What is the global period for CPT 92145?

CPT 92145 has no global period (indicator XXX). There are no post-operative day restrictions tied to this code. Refer to CMS National Physician Fee Schedule rules and any applicable NCCI edits when billing on the same date as other services.

What codes bundle with CPT 92145?

CPT 92145 has NCCI Procedure-to-Procedure edits with 4+ codes including 36591, 36592, 96523. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.

CMS Medicare Physician Fee ScheduleNCCI Edits · Current QuarterAMA CPT Code Set

CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.

Free 90-Day AR Recovery Audit

We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.