CPT 92020 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 92020 by major payers:
$32.54
$33.08
$34.69
$43.67
| 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 92020 | ||||||
United | 92020 | $30.76 | 1629142302 - AJMAL BAIG | 203447054 | FL | Surgery Physician (208600000X) |
United | 92020 | $16.06 | 1346231495 - MICHAEL HERR | 10564898 | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $19.02 | 1952438202 - EYE DOCTORS OF WASHINGTON PC, EYE DOCTORS OF WASHINGTON | 521759220 - (MD) EYE DOCTORS OF WASHINGTON, P.C. | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $22.45 | 1629076179 - RICHARD ADLER | 843421251 | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $65.23 | 1871733733 - HATICE SEN | 522220700 - MEDICAL FACULTY ASSOCIATES INC | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $60.33 | 1750330502 - SHANNATH MERBS | 526148737 - (MD) UNIVERSITY OF MARYLAND EYE ASSOCIATION PA | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $22.45 | 1144569724 - NEAL ADAMS MD PC | 461918538 - (MD) NEAL ADAMS MD PC | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $44.54 | 1669903712 - COLOMBE CASTELLUCCI | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Surgery Physician (208600000X) |
United | 92020 | $16.60 | 1891072633 - ELENA MIER-TROTTER | 474009477 - (MD) ARGOS VISION CENTER LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $35.90 | 1295267714 - MELEHA AHMAD | 943281660 | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $26.62 | 1457586299 - REENA GARG | 742518398 - (MD) VISIONARY OPHTHALMOLOGY, LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $17.31 | 1891823266 - ATHANASIUS GEORGE | 200711201 | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $26.62 | 1245427756 - SAMAN F GHAHREMANI MDPC, MARYLAND EYE CARE CENTER | 200675703 - (MD) SAMAN F. GHAHREMANI MDPC | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $26.68 | 1356383293 - MARK PRESLAN | 270582254 - (MD) MARK W PRESLAN MD LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92020 | $17.31 | 1295765774 - JOHN MILLER | 520741401 - (MD) BARENBURG OPTOMETRIC SERVICES, INC. | MD | 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 92020 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92020 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 92020 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 |
| 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 |
| 92015-CPT | Low | Determination Of Refractive State |
| 92020-CPT | Low | Gonioscopy W/Medical Dx Evaluation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92020. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92020 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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