92242 Medicaid reimbursement rates by state
Eye exams and vision services. 22 state Medicaid programs publish a fee-for-service rate for 92242 at the physician psychologist level. Rates run from $44.41 in New York to $346.30 in Arizona, with a median of $165.13.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 22
- Median rate
- $165.13units vary by state
- Highest
- $346.30Arizona
- Medicare (non-facility)
- $294.37–$473.492026 physician fee schedule
92242 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $346.30since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $244.79since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $242.03since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $223.59since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $207.76since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $205.48since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Practitioner Fee Schedule (2026-01-01) |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $196.64since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| MichiganIndependent (non-agency) provider · Michigan Medicaid (fee-for-service) | $180.20since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Independent Diagnostic Testing Fac |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $178.49since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Physician-related services fee sched |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $173.74since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $166.41since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $163.85since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $162.79since 2023-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $146.90since 2022-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Radiology - T |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $146.88since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Physician Maximum Allowed Fee Schedule - |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $146.57since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $138.73since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Independent Di |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $132.43since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $126.13since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $68.48since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| PennsylvaniaPhysician or licensed psychologist (incl. BCBA-D) · Pennsylvania Medical Assistance (fee-for-service) | $51.37since 2017-08-07 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $44.41since 2023-01-01 | unit | — | Plans negotiate; applies out of network | — | eMedNY Physician Fee Schedule Sect 2 (Me |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 92242?
It depends on the state. Of the 22 states with a published fee-for-service rate, the median is $165.13. Arizona pays the most ($346.30) and New York the least ($44.41 per unit).
Which state pays the highest Medicaid rate for 92242?
Arizona, at $346.30, effective 2026-10-01.
Do managed-care plans pay the same rate for 92242?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.
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Track 92242 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.