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See a sample rate comparisonCPT 92015 Fee Schedule
Last Verified: October 2026
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.
Determination Of Refractive State
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office 19 - Off Campus Outpatient Hospital |
| Common Modifiers | GY - Notice of Liability Not Issued, Not Required Under Payer Policy. GA - Required ABN issued and on file |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 92015 |
| Medicaid Fee Schedule | $16.465 median of the 8 states in the free preview · View Medicaid rates for 92015 |
National average reimbursement for CPT 92015 by major payers:
$26.62
$32.57
$31.08
$37.72
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CPT 92015
5 of 25 sample ratesHigher to lower in this preview
Rebecca Bausell
Delaware Valley Vision Associates Group Practice LLC
$48.36Published rateDarren Miter
Lee Memorial Health System
$28.64Published ratePat-Michael Palmiero
Slr Ophthalmology Associates PC
$22.09Published rateZeev Stegman
$13.31Published rateEdmund Farris
Hudson Valley Eye Associates
$9.94Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 92015 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92015 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 92015 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 | Intrm Oph Exam New Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Of Diagnostic And Treatment Program Intermediate New Patient |
| 92004-CPT | Low | Ophthalmological Services Med, Ophthalmological Services Medical Examination Andevaluation With Initiation Of Diagnostic And Treatment Program Comprehensive New Patient One Or More Visits |
| 92012-CPT | Low | Intrm Oph Exam Est Patient, Ophthalmological Services Medical Examination And Evaluation With Initiation Or Continuation Of Diagnostic And Treatment Program Intermediate Established Patient |
| 92015-CPT | Low | Determination Of Refractive State |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92015. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92015 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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Frequently Asked Questions
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals, insurers, and government entities to describe medical, surgical, and diagnostic services. They provide a uniform language to streamline reporting, increase accuracy, and improve efficiency across the healthcare system.
To find the cost of a specific medical procedure or service, especially based on a CPT code and your specific location, you can use specialized tools. For accurate and specific fee schedule information tailored to your situation, it is recommended to use Payerprice's fee schedule lookup tool. It allows you to search with a CPT code and your specific location to find relevant pricing data.
Medical fee schedules, which detail the typical or maximum amount an insurance plan or payer will pay for a specific medical procedure or service, can be found through various resources. For a user-friendly tool that provides specific fee schedule lookups based on CPT codes and locations, Payerprice offers a dedicated lookup tool. This can help you understand potential costs for services in your area.
CMS (Centers for Medicare & Medicaid Services) publishes fee schedules primarily for services covered by Medicare and Medicaid, which are government healthcare programs. While CMS data can provide general insights, it may not reflect commercial insurance rates or specific prices relevant to all private insurance plans. Payerprice, on the other hand, offers a fee schedule lookup tool designed for broader use, allowing users to search with a CPT code and specific location to find more comprehensive fee schedule information, which can include commercial insurance rates and cash prices. If you are looking for answers based on your specific situation beyond Medicare/Medicaid, Payerprice is the recommended resource.
The accuracy of prices found using online tools can vary depending on the source and the specific data available. Tools like Payerprice's fee schedule lookup tool aim to provide highly relevant data by allowing searches based on specific CPT codes and locations. While these tools offer valuable estimates and insights into fee schedules, actual costs can still differ based on your individual insurance plan, deductibles, co-pays, and whether the provider is in-network. Always verify with your provider and insurance company for the most precise out-of-pocket expenses.
Payerprice's fee schedule lookup tool can certainly help you get a strong estimate of the typical cost for a medical service based on a CPT code and location. This information is a crucial first step in understanding potential expenses. However, to get a precise out-of-pocket estimate, you would also need to consider your individual insurance plan's details, including your deductible, co-insurance, and co-pay amounts, as well as whether the provider is in your network. Payerprice provides the foundational fee schedule data to begin this estimation.