Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 92228 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | $30.40 national non-facility rate (2026) · View Medicare rates for 92228 |
| Medicaid Fee Schedule | $25.04 median of the 8 states in the free preview · View Medicaid rates for 92228 |
National average reimbursement for CPT 92228 by major payers:
$37.31
$40.92
$38.06
$58.15
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 92228.
CPT 92228
5 of 25 sample ratesHigher to lower in this preview
Peter Heydemann
Pediatric Faculty Foundation In
$73.72Published rateGeorge Gianakakos
Loyola University Medical Center
$57.95Published rateLubov Romantseva
Pediatric Faculty Foundation In
$31.44Published rateHaidar Kabbani
Trihealth G, LLC
$19.97Published rateClint Anthony
$12.93Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 92228 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92228 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 92228 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 92228. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92228 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 92228) and we'll show you how you compare in 15 minutes or less.