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See a sample rate comparisonCPT 92201 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | $25.05 national non-facility rate (2026) · View Medicare rates for 92201 |
| Medicaid Fee Schedule | $20.35 median of the 8 states in the free preview · View Medicaid rates for 92201 |
National average reimbursement for CPT 92201 by major payers:
$27.33
$27.40
$24.46
$46.29
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CPT 92201
5 of 25 sample ratesHigher to lower in this preview
James Handa
Johns Hopkins University
$88.91Published rateAllen Hu
Cumberland Valley Retina Consu
$25.72Published ratePeter Filipov
Azar/Filipov, M.D.,P.A.
$21.51Published rateRenee Bovelle
$18.57Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$10.76Published rate
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See a sample payer proposalCPT 92201 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92201 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 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 |
|---|---|---|
| 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). |
| 92145-CPT | Low | Corneal Hysteresis Determinati, Corneal Hysteresis Determination By Air Impulse Stimulation Unilateral Or Bilateral With Interpretation And Report |
| 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 |
| 92202-CPT | Low | Opscpy Extnd On Mac Draw, Ophthalmoscopy Extended With Drawing Of Optic Nerve Or Macula Eg For Glaucoma Macular Pathology 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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