CPT 92136 Fee Schedule
Last Updated: August 2025
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 • 24 - Ambulatory Surgical Center • 22 - On Campus-Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional Component Only (separate from technical component) • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 92136 by major payers:
$77.86
$87.54
$83.57
$98.62
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Related Codes
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92136. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92136 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.
CPT 92136 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92136 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 92136 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 92083 | Low | Visual Field Examination Unilateral Or Bilateral With Interpretation And Report; Extended Examination (Eg Goldmann Visual Fields With At Least 3 Isopters Plotted And Static Determination Within The Central 30 Degree Or Quantitative Automated Threshold Perimetry Octopus Program G-1 32 Or 42 Humphrey Visual Field Analyzer Full Threshold Programs 30-2 24-2 Or 30/60-2) |
| 92132 | Low | Scanning Computerized Ophthalmic Diagnostic Imaging, Anterior Segment, With Interpretation And Report, Unilateral Or Bilateral |
| 92134 | Low | Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment, With Interpretation And Report, Unilateral Or Bilateral; Retina |
| 92136 | Low | Ophthalmic Biometry By Partial Coherence Interferometry With Intraocular Lens Power Calculation |
See what providers are getting paid in 2025 for 92136:
CPT 92136 Fee Schedule & Reimbursement Rates
The CPT 92136 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. BCBS National Rate | More Info |
|---|---|---|---|
| 92083 | $36.95 | $74.02 | |
| 92132 | $15.31 | $39.22 | |
| 92134 | $24.30 | $49.68 | |
| 92136 | $29.63 | $77.86 | |
| 92145 | $5.33 | $16.36 | |
| 92201 | $24.63 | $30.96 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is Price Transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
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