Ophthalmology · Wisconsin
Ophthalmology commercial reimbursement in Wisconsin
How Wisconsin ophthalmology rates compare with the national market.
Ophthalmology in Wisconsin
42 codes · 104 sampled providers
Index vs national
164
64% above
Rank among states
4 of 50
1 = highest
Codes above national
42 of 42
median code at 164%
Providers
104
sampled
What the data shows
1
Ophthalmology ranks 4th of 50 states in Wisconsin with an index of 164 (100 = the specialty's national median), across 42 codes and 104 sampled providers.
2
Of the 42 ophthalmology codes with enough data in Wisconsin, 42 pay above the national median and 0 below; the typical code sits at 164% of the national median.
3
Largest premium over the national median: CPT 20610 (Drain/inj joint/bursa w/o us) at 197%; largest discount: CPT 65778 (Cover eye w/membrane) at 124%.
4
Measured against Medicare, Wisconsin ophthalmology rates have a median of 199% of the Medicare rate across these codes.
Codes above and below the national median
The five largest gaps in each direction
Highest vs national
All ophthalmology codes in Wisconsin
Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
| Code | Wisconsin | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 20610 Drain/inj joint/bursa w/o us | $136 | $69 | +97% | 198% | 104 | 143 | |
| CPT 92025 Cptrized corneal topography | $72 | $40 | +80% | 195% | 102 | 154 | |
| CPT 15823 Blepharp upr eyelid xcsv skn | $1,208 | $677 | +78% | 191% | 104 | 156 | |
| CPT 92242 Fluorescein&icg angiography | $511 | $288 | +78% | 152% | 104 | 154 | |
| CPT 67904 Repair eyelid defect | $1,448 | $816 | +77% | 194% | 104 | 156 | |
| CPT 92273 Full field erg w/i&r | $246 | $142 | +73% | 199% | 104 | 157 | |
| CPT 92083 Extended visual field xm | $126 | $73 | +72% | 197% | 104 | 156 | |
| CPT 92020 Gonioscopy | $45 | $26 | +72% | 170% | 104 | 154 | |
| CPT 68761 Close tear duct opening | $282 | $164 | +72% | 197% | 104 | 156 | |
| CPT 92202 Opscpy extnd on/mac draw | $29 | $17 | +71% | 184% | 104 | 155 | |
| CPT 66821 After cataract laser surgery | $672 | $393 | +71% | 201% | 100 | 158 | |
| CPT 92004 Compre oph exam new pt 1/> | $210 | $124 | +69% | 140% | 104 | 166 | |
| CPT 92201 Opscpy extnd rta draw uni/bi | $45 | $27 | +69% | 178% | 104 | 157 | |
| CPT 65855 Trabeculoplasty laser surg | $517 | $307 | +68% | 210% | 100 | 156 | |
| CPT 65820 Goniotomy | $1,606 | $955 | +68% | 222% | 87 | 156 | |
| CPT 99203 Office o/p new low 30 min | $169 | $101 | +67% | 144% | 104 | 157 | |
| CPT 92014 Compre oph exam est pt 1/> | $169 | $101 | +67% | 272% | 104 | 166 | |
| CPT 99212 Office o/p est sf 10 min | $71 | $43 | +66% | 119% | 104 | 157 | |
| CPT 99215 Office o/p est hi 40 min | $245 | $148 | +65% | 127% | 104 | 156 | |
| CPT 99213 Office o/p est low 20 min | $120 | $73 | +65% | 126% | 104 | 157 | |
| CPT 99204 Office o/p new mod 45 min | $259 | $158 | +64% | 146% | 104 | 157 | |
| CPT 99214 Office o/p est mod 30 min | $175 | $107 | +64% | 129% | 104 | 157 | |
| CPT 67210 Treatment of retinal lesion | $1,076 | $659 | +63% | 208% | 100 | 155 | |
| CPT 65756 Corneal trnspl endothelial | $2,316 | $1,425 | +63% | 234% | 84 | 147 | |
| CPT 99205 Office o/p new hi 60 min | $332 | $205 | +62% | 140% | 104 | 156 | |
| CPT 67028 Injection eye drug | $220 | $137 | +60% | 192% | 103 | 155 | |
| CPT 66991 Xcapsl ctrc rmvl insj 1+ | $1,341 | $840 | +60% | 230% | 84 | 148 | |
| CPT 67036 Removal of inner eye fluid | $1,753 | $1,117 | +57% | 231% | 84 | 148 | |
| CPT 92133 Cptrzd oph dx img pst sgm on | $66 | $42 | +56% | 216% | 104 | 155 | |
| CPT 92235 Fluorescein angrph mltiframe | $223 | $145 | +54% | 137% | 104 | 154 | |
| CPT 92134 Cptrz oph dx img pst sgm rta | $68 | $45 | +52% | 209% | 104 | 155 | |
| CPT 92012 Intrm oph exam est patient | $115 | $76 | +52% | 278% | 104 | 166 | |
| CPT 92250 Fundus photography w/i&r | $80 | $53 | +52% | 216% | 104 | 156 | |
| CPT 67840 Remove eyelid lesion | $383 | $253 | +51% | 285% | 84 | 146 | |
| CPT 92136 Ophthalmic biometry | $104 | $69 | +50% | 215% | 104 | 155 | |
| CPT 67042 Vit for macular hole | $2,231 | $1,494 | +49% | 234% | 84 | 147 | |
| CPT 66982 Xcapsl ctrc rmvl cplx wo ecp | $1,460 | $981 | +49% | 231% | 84 | 148 | |
| CPT 67108 Repair detached retina | $2,323 | $1,594 | +46% | 234% | 84 | 148 | |
| CPT 66984 Xcapsl ctrc rmvl w/o ecp | $1,067 | $738 | +45% | 231% | 83 | 148 | |
| CPT 76512 Oph us dx b-scan | $98 | $70 | +40% | 201% | 98 | 152 | |
| CPT 93000 Electrocardiogram complete | $28 | $21 | +36% | 185% | 85 | 138 | |
| CPT 65778 Cover eye w/membrane | $87 | $70 | +24% | 243% | 82 | 139 |
Frequently asked questions
How do Wisconsin ophthalmology rates compare with the rest of the country?
Wisconsin ranks 4th of 50 states with an index of 164; 42 of 42 codes are above the national median.
Which ophthalmology code has the biggest premium in Wisconsin?
CPT 20610 (Drain/inj joint/bursa w/o us), at 197% of the national median.
Are these Medicare or commercial rates?
Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.
Methodology
How these numbers are calculated
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Wisconsin ophthalmology contracts
Compare your rates with these medians.