CPT 92235 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 92235 by major payers:
$160.98
$137.79
$160.74
$217.00
| 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 92235 | ||||||
United | 92235 | $191.41 | 1063741163 - AZTEC URGENT CARE, LLC | 271495988 - (NM) AZTEC URGENT CARE LLC | NM | Urgent Care Clinic/Center (261QU0200X) |
United | 92235 | $132.17 | 1952776023 - KRISTINA JIMENEZ | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Family Nurse Practitioner (363LF0000X) |
United | 92235 | $35.84 | 1528226248 - RADIOLOGY CLINICS OF LAREDO | 742652532 - (TX) RADIOLOGY CLINICS OF LAREDO | TX | Radiology Clinic/Center (261QR0200X) |
United | 92235 | $49.59 | 1548859895 - ALICIA ENCINAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | CA | Family Nurse Practitioner (363LF0000X) |
United | 92235 | $77.13 | 1053515130 - MIGUEL A. ARENAS, M.D., PC | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
United | 92235 | $412.07 | 1477874337 - RCHP, NORTH ALABAMA MEDICAL CENTER | 272451336 | AL | General Acute Care Hospital (282N00000X) |
United | 92235 | $520.34 | 1689653305 - WILLIAM BEAUMONT HOSPITAL, COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL | 381459362 - WILLIAM BEAUMONT HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 92235 | $1610.88 | 1326564071 - MULTICARE HEALTH SYSTEM, MULTICARE COVINGTON MEDICAL CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 92235 | $83.08 | 1174512115 - MICHAEL GUILLETTE | 271495988 - (NM) AZTEC URGENT CARE LLC | CO | Physician Assistant (363A00000X) |
United | 92235 | $114.09 | 1639266224 - BEACH MEDICAL IMAGING, PA | 651078048 - (FL) BEACH MEDICAL IMAGING PA | FL | Radiology Clinic/Center (261QR0200X) |
United | 92235 | $97.81 | 1730304940 - PROSPECT IMAGING CENTER, LLC | 201509687 - (IL) PROSPECT IMAGING CENTER LLC | IL | Radiology Clinic/Center (261QR0200X) |
United | 92235 | $1421.32 | 1235685330 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH OP RADIOLOGY | 811723202 - PRISMA HEALTH - UPSTATE | SC | Radiology Clinic/Center (261QR0200X) |
United | 92235 | $97.81 | 1467409540 - MOLECULAR IMAGING OF SUBURBAN CHICAGO, LLC | 201675608 - (IL) MOLECULAR IMAGING OF SUBURBAN CHICAGO LLC | IL | Radiology Clinic/Center (261QR0200X) |
United | 92235 | $88.04 | 1063423382 - STEEPLECHASE DIAGNOSTIC CENTER INC, AMERICAN HEALTH IMAGING OF STEEPLECHASE | 760202144 | TX | Radiology Clinic/Center (261QR0200X) |
United | 92235 | $88.04 | 1841471471 - NEXT GENERATION IMAGING | 208967541 - (TN) NEXT GENERATION IMAGING | TN | Radiology Clinic/Center (261QR0200X) |
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 92235 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92235 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 92235 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 | Remote Imaging For Detection Of Retinal Disease (Eg, Retinopathy In A Patient With Diabetes) With Analysis And Report Under Physician Supervision, Unilateral Or Bilateral |
| 92228-CPT | Low | Imaging Of Retina For Detection Or Monitoring Of Disease; With Remote Physician Or Other Qualified Health Care Professional Interpretation And Report Unilateral Or Bilateral (Desc Rvsd 1/1/21) |
| 92230-CPT | Low | Ophthalmoscpy;Fluorescein Angioscpy |
| 92235-CPT | Low | Fluorescein Angiography (Includes Multiframe Imaging) With Interpretation And Report Unilateral Or Bilateral. (Desc Revised 1/1/2017) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92235 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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