92012 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 92012

Payer coverage policies that name 92012

92012 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island.

PayerPolicyRole in policyReviewedDocument
AetnaAsfotase alfa (Strensiq) (0901)listed, no stance (range 92012-92014)Jan 13, 2026payer document
AetnaCataract Surgery (0508)
Femtosecond laser-assisted cataract surgery, capsular tension rings (e.g., StabilEyes)
covered if criteria are met (range 92012-92014)Oct 9, 2026payer document
AetnaEye Prosthesis (0619)covered if criteria are met (range 92002-92014)Sep 24, 2026payer document
Blue Cross & Blue Shield of MississippiCorneal Topographycomputerassisted Corneal Topographyphotokeratoscopy (L.9.03.408)listed, no stance (range 92002-92014)payer document
Blue Cross & Blue Shield of Rhode IslandOphthalmology Examination and Routine Eye Examcovered if criteria are metMar 6, 2024payer document

Medicaid fee-for-service

  • AZ: $39.40 (outpatient_hospital, RF133), effective Oct 1, 2025
  • CO: $73.61 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $34.01 (physician, facility), effective Jan 1, 2026
  • IL: $33.12 (practitioner), effective Apr 1, 2024
  • IN: $39.13 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $42.11 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $46.92 (physician, facility), effective Jan 1, 2026
  • LA: $69.74 (professional), effective Jul 1, 2025
  • MA: $37.52 (physician_medicine, facility), effective May 1, 2024
  • MS: $72.55 (comprehensive), effective Jul 1, 2020
  • MT: $47.81 (optometric, facility), effective Jul 1, 2025
  • ND: $101.01 (physician), effective Aug 1, 2026
  • NE: $33.32 (physician, facility), effective Jul 1, 2026
  • NY: $30.30 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $19.37 (physician, facility), effective Jan 1, 2024
  • OK: $37.60 (physician, facility), effective Jul 1, 2026
  • TX: $40.28 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Apr 1, 2016
  • VA: $35.88 (medical, facility), effective Jul 1, 2026
  • VT: $103.38 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $24.65 (physician, facility), effective Jul 1, 2026
  • WY: $58.88 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.