CPT 92201 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 | Ophthalmoscopy Procedures Special Ophthalmological Services and Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 92201 |
National average reimbursement for CPT 92201 by major payers:
$27.33
$27.40
$24.46
$46.29
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 92201 | $88.91 | 1811946874 - JAMES HANDA | 520595110 - JOHNS HOPKINS UNIVERSITY | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $18.57 | 1588732424 - RENEE BOVELLE | 651233615 | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $55.81 | 1861464323 - ALEXANDER TSANG | 60646668 - HARTFORD HOSPITAL | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $22.50 | 1588732424 - RENEE BOVELLE | 651233615 | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $21.44 | 1164406112 - JANINE SMITH-MARSHALL | 274268021 - (MD) METROPOLITAN PEDIATRIC OPTHALMOL | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $25.72 | 1235315268 - ALLEN HU | 521946106 - (MD) CUMBERLAND VALLEY RETINA CONSU | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $30.11 | 1235122029 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 92201 | $21.51 | 1447239504 - JAMES GALLAGHER | 521622192 - AZAR/FILIPOV, M.D.,P.A. | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $21.51 | 1811990039 - PETER FILIPOV | 521622192 - AZAR/FILIPOV, M.D.,P.A. | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $25.03 | 1780235820 - CHESAPEAKE EYE CARE & LASER CENTER LLC | 522124249 - CHESAPEAKE EYE CARE & LASER CENTER, P.C. | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $10.76 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 92201 | $18.57 | 1023017142 - MARC HONIG | 521092719 - (MD) BRULL & HONIG, M.D., P.A. | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $24.29 | 1649478066 - JAMES & DYER, M.D.,P.A., ALDEN JAMES, M.D.,P.A. | 522102537 - (MD) JAMES & DYER MD PA | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $18.32 | 1790797793 - SINA SABET | 542059189 - (VA) SINA J SABET MD PC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $69.76 | 1457586299 - REENA GARG | 454019056 | 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 92201 vs. Other Special Ophthalmological Services and Procedures Codes
The CPT 92201 code is part of the Ophthalmoscopy Procedures services used for Special Ophthalmological 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 92201 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 |
|---|---|---|
| 92025-CPT | Low | Test To Analyze Cornea Shape, Test That Uses A Computer To Produce An Image And Analyze The Shape Of The Cornea (The Transparent Covering Of The Eye). |
| 92060-CPT | Low | Sensorimotor Examination, Sensorimotor Examination With Multiple Measurements Of Ocular Deviation (Eg Restrictive Or Paretic Muscle With Diplopia) With Interpretation And Report (Separate Procedure) |
| 92136-CPT | Low | Measure For Eye Lens Implant, Eye Measurements Are Taken To Create A Personalized Lens Implant; Used To Treat Cataracts (A Clouding Of The Lens In The Eye). |
| 92201-CPT | Low | Opscpy Extnd Rta Draw Uni Bi, Ophthalmoscopy Extended With Retinal Drawing And Scleral Depression Of Peripheral Retinal Disease Eg For Retinal Tear Retinal Detachment Retinal Tumor With Interpretation And Report Unilateral Or Bilateral |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92201. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92201 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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