CPT 92004 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Ophthalmology Services and Procedures |
| Common Place of Service | • 11 - Office • None |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 57 - Decision for surgery |
| Complexity Level | Low |
National average reimbursement for CPT 92004 by major payers:
$136.57
$174.07
$179.83
$198.09
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 92004 | ||||||
United | 92004 | $106.69 | 1649374356 - KENNETH POMPILIO | 521760647 | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $125.77 | 1700889755 - AZAR/FILIPOV MD PA | 521622192 - AZAR/FILIPOV, M.D.,P.A. | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $113.80 | 1811069495 - JEREMY SNOW | 522171086 - (MD) JEREMY S. SNOW, M.D., P.A. | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $330.79 | 1174771232 - JANET ALEXANDER | 526148737 - (MD) UNIVERSITY OF MARYLAND EYE ASSOCIATION PA | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $273.67 | 1477670461 - LOUIS KRAUS | 911780160 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92004 | $106.47 | 1457388837 - BRUCE JONES | 521417115 - (MD) IVAN H. GARCIA, MD, P.C. T/A OMNI EYE SPECIALISTS | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $39.00 | 1255304788 - EBUBE ODUNUKWE | 581910859 - NATIONAL VISION, INC. | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $84.25 | 1265538540 - SANJAY GOEL | 850942615 - (MD) GOEL VISION COLUMBIA | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $328.17 | 1437174430 - OLIVER SCHEIN | 520595110 - JOHNS HOPKINS UNIVERSITY | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $328.17 | 1194875864 - NICHOLAS MAHONEY | 520595110 - JOHNS HOPKINS UNIVERSITY | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $139.86 | 1013943950 - MELVIN WAGNER | 474664931 - (PA) STOKEN WAGNER OPHTHALMIC ASSOCIATES, LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $410.82 | 1376839217 - MEGHAN BERKENSTOCK | 520595110 - JOHNS HOPKINS UNIVERSITY | MD | Ophthalmology Physician (207W00000X) |
United | 92004 | $167.72 | 1821087859 - RYAN MCKINNON | 866007596 - (AZ) YUMA REGIONAL MEDICAL CENTER | AZ | Ophthalmology Physician (207W00000X) |
United | 92004 | $104.63 | 1922300425 - AJ COTTINGHAM JR MD ,PLLC | 272386441 - (TX) AJ COTTINGHAM JR MD PLLC | TX | Ophthalmology Physician (207W00000X) |
United | 92004 | $162.61 | 1588753909 - JOSEPH ZEITER | 911854979 - ZEITER EYE MEDICAL GROUP, INC. | CA | Ophthalmology Physician (207W00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 92004 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92004 code is part of the Medicine Services and Procedures services used for Ophthalmology Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 92004 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 92002-CPT | Low | Ophthalmological Services: Medical Examination And Evaluation With Initiation Of Diagnostic And Treatment Program; Intermediate, New Patient |
| 92004-CPT | Low | Ophthalmological Services: Medical Examination And Evaluation With Initiation Of Diagnostic And Treatment Program; Comprehensive, New Patient, 1 Or More Visits |
| 92012-CPT | Low | Ophthalmological Services: Medical Examination And Evaluation, With Initiation Or Continuation Of Diagnostic And Treatment Program; Intermediate, Established Patient |
| 92014-CPT | Low | Ophthalmological Services: Medical Examination And Evaluation, With Initiation Or Continuation Of Diagnostic And Treatment Program; Comprehensive, Established Patient, 1 Or More Visits |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92004 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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