CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Ophthalmology
92004 — Ophthalmological services; new patient, comprehensive, with medical decision making of low or higher complexity
This is a complete eye exam for a new patient that includes a detailed history, external and internal examination of the eye, and initiation of a diagnostic and treatment program.
- Typical setting: Eye doctor's office
- National avg charge (illustrative): $150–$350 (comprehensive new patient ophthalmology exam)
- Most-disputed reason: Billing 92004 for routine refraction exams — refraction (determining eyeglass prescriptions) is separately billable as 92015 and is not included in exam codes; refraction billed alone under 92004 is improper.
What it means
What 92004 actually means
This is a complete eye exam for a new patient that includes a detailed history, external and internal examination of the eye, and initiation of a diagnostic and treatment program. It requires medical decision-making of at least low complexity.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing 92004 for routine refraction exams — refraction (determining eyeglass prescriptions) is separately billable as 92015 and is not included in exam codes; refraction billed alone under 92004 is improper.
- Billing 92004 for an established patient — patients seen within the past 3 years by the same physician or group must be billed under established patient codes (92012/92014).
- Bundling ancillary tests (visual fields, retinal photography) into the exam code when those tests have their own separate CPT codes and are billed additionally.
If you see 92004 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 92004 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 92004 on a bill.
92004 FAQ
Plain-English answers.
What does 92004 usually cost?
$150–$350 (comprehensive new patient ophthalmology exam). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 92004?
Billing 92004 for routine refraction exams — refraction (determining eyeglass prescriptions) is separately billable as 92015 and is not included in exam codes; refraction billed alone under 92004 is improper.
What should I do if I see 92004 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 92004 before paying.
Don't pay 92004 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.