CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Ophthalmology
92250 — Fundus photography with interpretation and report
This is a specialized photograph of the inside of your eye (the retina and optic nerve) taken to document and monitor conditions like diabetic retinopathy, macular degeneration, or glaucoma.
- Typical setting: Eye doctor's office
- National avg charge (illustrative): $50–$200 (combined technical and professional components)
- Most-disputed reason: Billing 92250 for every eye exam regardless of medical indication — fundus photography must be medically necessary (e.g., for monitoring diabetic eye disease or a suspicious lesion) and not just for routine documentation.
What it means
What 92250 actually means
This is a specialized photograph of the inside of your eye (the retina and optic nerve) taken to document and monitor conditions like diabetic retinopathy, macular degeneration, or glaucoma. The code includes both the photography and the physician's written interpretation.
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 92250 for every eye exam regardless of medical indication — fundus photography must be medically necessary (e.g., for monitoring diabetic eye disease or a suspicious lesion) and not just for routine documentation.
- Billing 92250 without a documented physician interpretation and report — the code requires both the photograph and a written clinical interpretation; the photograph alone is not sufficient.
- Facilities charging separately for the photography setup/equipment and the physician charging for interpretation without -TC and -26 modifiers properly delineating the components.
If you see 92250 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 92250 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 92250 on a bill.
92250 FAQ
Plain-English answers.
What does 92250 usually cost?
$50–$200 (combined technical and professional components). 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 92250?
Billing 92250 for every eye exam regardless of medical indication — fundus photography must be medically necessary (e.g., for monitoring diabetic eye disease or a suspicious lesion) and not just for routine documentation.
What should I do if I see 92250 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 92250 before paying.
Don't pay 92250 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.