CPT 92227 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 None |
| Common Modifiers | None PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 92227 |
National average reimbursement for CPT 92227 by major payers:
$20.81
$16.56
$17.93
$33.92
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 92227 | $23.44 | 1942650130 - MALIK NASSAN | 362679194 - (IL) HEAD & NECK AND COSMETIC SURGERY ASSOCIATES, LLC | IL | Psychiatry Physician (2084P0800X) |
United | 92227 | $22.62 | 1629181037 - DUKE RUKTANONCHAI | 742958277 - SCOTT & WHITE CLINIC | PA | Psychiatry Physician (2084P0800X) |
United | 92227 | $13.89 | 1922328426 - MAJED DALLOUL | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Psychiatry Physician (2084P0800X) |
United | 92227 | $9.15 | 1225058332 - SHERRIE LEVY | 371140016 - CARLE HEALTH CARE INCORPORATED | IL | Psychiatry Physician (2084P0800X) |
United | 92227 | $28.95 | 1811068554 - JAMES MACKENZIE | 205734385 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92227 | $24.79 | 1821097924 - AFTAB POSHNI | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 92227 | $28.95 | 1659732584 - JOANNA GARCIA PIERCE | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92227 | $13.28 | 1912620980 - NIDHI MEHTA | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 92227 | $25.68 | 1578531950 - DAVID RITACCO | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92227 | $25.68 | 1386800662 - NICHOLAS HATZIS | 205734385 | IL | Psychiatry Physician (2084P0800X) |
United | 92227 | $24.79 | 1558867523 - SULAIMAN FAROOQUI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 92227 | $23.79 | 1518037126 - MARY LAKE | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92227 | $10.06 | 1710244991 - ALBA PERGJIKA | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92227 | $30.12 | 1558997593 - CYRIL APPIAGYEI | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 92227 | $24.79 | 1306474986 - MELVIN JOSEPH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
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 92227 vs. Other Special Ophthalmological Services and Procedures Codes
The CPT 92227 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 92227 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 |
|---|---|---|
| 92227-CPT | Low | Screening For Retina Disease, An Eye Scan To Check For Disease Of The Retina (Part Of The Eye That Helps Create Images). The Scan Is Used Often To Check For Eyesight Problems Related To Diabetes (Diabetic Retinopathy). |
| 92228-CPT | Low | Scan To Monitor Eye Disease, A Scan Given Periodically To Assess Health Of The Eyes After A Disease Affecting The Retina (Diabetic Retinopathy) Has Been Diagnosed. The Retina Helps The Eyes To Create Images. |
| 92229-CPT | Low | Screening For Retina Disease, An Eye Scan To Check For Disease Of The Retina (Part Of The Eye That Helps Create Images). The Scan Is Used Often To Check For Eyesight Problems Related To Diabetes (Diabetic Retinopathy). |
| 92235-CPT | Low | X-Ray Of Eye Blood Vessels, Examination And X-Ray Of The Inside Of Blood Vessels In The Eye. Dye Makes The Area Of Interest Easier To See. The Procedure Is Used To Evaluate Problems With The Retina. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92227. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92227 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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