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 | • Medicine Services and Procedures • Ophthalmology 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 |
National average reimbursement for CPT 92201 by major payers:
$27.33
$27.40
$24.46
$34.27
| 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 92201 | ||||||
United | 92201 | $88.91 | 1437174430 - OLIVER SCHEIN | 520595110 - JOHNS HOPKINS UNIVERSITY | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $16.25 | 1598961484 - KATHRYN KLEIN | 223581575 | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $28.56 | 1174586200 - MICHAEL ALTMAN | 520486540 - SINAI HOSPITAL OF BALTIMORE INC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $54.74 | 1740817626 - HYUNJIN CHOI | 526148737 - (MD) UNIVERSITY OF MARYLAND EYE ASSOCIATION PA | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $20.19 | 1245660075 - NORTHEAST EYE SURGEONS PA | 464026869 - (MD) NORTHEAST EYE SURGEONS 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 | $19.45 | 1124434063 - SNEH DHANNAWAT | 521917485 - (MD) PHYSICIANS EYE CARE CENTER, LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $37.24 | 1437569936 - AKOSUA NTI | 208346981 - ASSOCIATED RETINAL CONSULTANTS, LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $20.19 | 1851354500 - NEAL ADAMS | 461918538 - (MD) NEAL ADAMS MD PC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $26.54 | 1447293519 - MARC HIRSCHBEIN | 471201762 - (PA) OLKOWSKI OPHTHALMOLOGY PC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $39.18 | 1417973785 - SAMUEL FRIEDEL | 526148737 - (MD) UNIVERSITY OF MARYLAND EYE ASSOCIATION PA | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $28.59 | 1780800359 - PHYSICIANS EYE CARE CENTER LLC | 521917485 - (MD) PHYSICIANS EYE CARE CENTER, LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $20.19 | 1144569724 - NEAL ADAMS MD PC | 461918538 - (MD) NEAL ADAMS MD PC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $19.26 | 1548798002 - SUNIL BELLUR | 262080927 - (MD) WASHINGTON EYE INSTITUTE LLC | MD | Ophthalmology Physician (207W00000X) |
United | 92201 | $40.95 | 1568487361 - DAVID YEH | 10604605 - (MD) GMS MEDICAL EYE CENTER | 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 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 |
|---|---|---|
| 92025-CPT | Low | Computerized Corneal Topography Unilateral Or Bilateral With Interpretation And Report |
| 92060-CPT | Low | Sensorimotor Examination With Multiple Measurements Of Ocular Deviation (Eg, Restrictive Or Paretic Muscle With Diplopia) With Interpretation And Report (Separate Procedure) |
| 92136-CPT | Low | Ophthalmic Biometry By Partial Coherence Interferometry With Intraocular Lens Power Calculation |
| 92201-CPT | Low | 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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