Use the form below to enter the fees that your office charges for each procedure.
If your office does not use all the procedure codes listed, just leave them blank.
Code
Description
Other
Your Fee $
92002
Int. Opth. Ex., New
92012
Int. Opth. Ex., Est.
92004
Comp. Opth. Ex., New
without 92015
92014
Comp. Opth. Ex., Est.
without 92015
92015
Refraction
S0620
Rout. Ophth. Ex.+ Refraction, New
S0621
Rout. Ophth. Ex.+ Refraction, Est.
99201
Level 1 O. V. New
PF, PF, SF
99202
Level 2 O. V. New
EPF, EPF, SF
99203
Level 3 O. V. New
DET, DET, LOW
99204
Level 4 O. V. New
COM, COM, MOD
99205
Level 5 O. V. New
COM, COM, HIGH
99211
Level 1 O. V. Est
DR Supervision
99212
Level 2 O. V. Est
PF, PF, SF
99213
Level 3 O. V. Est
EPF, EPF, SF
99214
Level 4 O. V. Est
DET, DET, MOD
99215
Level 5 O. V. Est
COM, COM, HIGH
99241
Consult Level 1
PF, PF, SF
99242
Consult Level 2
EPF, EPF, SF
99243
Consult Level 3
DET, DET, LOW
99244
Consult Level 4
COM, COM, MOD
99307
NRSG, HM Care Subseq
PF, PF, SF
99308
NRSG, HM Care Subseq
EPF, EPF, LOW
99309
NRSG, HM Care Subseq
DET, DET, MOD
99310
NRSG, HM Care Subseq
COM, COM, HIGH
99334
Rest Home, Est
PF, PF, SF
99335
Rest Home, Est
EPF, EPF, LOW
99336
Rest Home, Est
DET, DET, MOD
99337
Rest Home, Est
COM, COM, MODHIGH
92020
Gonioscopy
Binocular
92081
Visual Field Limited
Binocular
92070
Fitting CL for Tx of Dx
Each
92082
Visual Field Intermediate
Binocular
92083
Visual Field Comp.
Binocular
92100
Tonometry, Serial
Binocular
92135
Ophthalmic Imaging
per Eye
92225
Ext. Ophthalmoscopy
PER EYE FEE
92226
Ext. Ophthal. Subseq.
PER EYE FEE
92250
Ext. Ophthal., with Photo
Binocular
92285
External Photography
92025
Corneal Topography
65205
FB Removal Conj., Super
65210
FB Removal Conj., Embed
65220
FB Removal Corneal, No SL
65222
FB Removal Corneal, SL
6698455
Cat. Surg w/ IOL, postop
per day
76514
Pachymetry (0025T/92499)
Bilateral
67820
Correction Trichiasis
67825
Epilation by electro or cryo
68761
Closure Punctum, Plug
68801
Dilation of Punctum, irrigation
68840
Probing of Canaliculi
65435
Debridement of Cornea
Name
Phone
Please print and mail these pages to Joyce at PMI!
Joyce Josie
PMI, LLC
321 West Fulton Street
P.O. Box 608
Waupaca, WI 54981
