CPT 92240 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 | Moderate |
National average reimbursement for CPT 92240 by major payers:
$223.02
$265.99
$252.74
$333.35
| 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 92240 | ||||||
United | 92240 | $82.00 | 1194974600 - GAURAV YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92240 | $302.76 | 1366890857 - STEVEN SHARP | 910844563 | OK | Psychiatry Physician (2084P0800X) |
United | 92240 | $257.22 | 1780847020 - AMBER KAZI | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 92240 | $68.02 | 1033215868 - MOHAMMED ALI | 320552496 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92240 | $374.80 | 1740252972 - DAVID HSU | 390884478 - BELLIN MEMORIAL HOSPITAL INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92240 | $81.48 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 92240 | $82.00 | 1821097924 - AFTAB POSHNI | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 92240 | $93.26 | 1962664789 - JAMIE EVANS | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 92240 | $68.51 | 1366890857 - STEVEN SHARP | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | OK | Psychiatry Physician (2084P0800X) |
United | 92240 | $46.90 | 1700328788 - LIMITLESS MEDICAL GROUP, LTD | 933955099 | IL | Psychiatry Physician (2084P0800X) |
United | 92240 | $93.26 | 1366890857 - STEVEN SHARP | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 92240 | $516.02 | 1295769297 - YOLANDA HOLLER-MANAGAN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92240 | $68.37 | 1265883375 - JOCELYN LORENZO | 274026658 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92240 | $374.80 | 1568752665 - ANDREW KNOX | 390884478 - BELLIN MEMORIAL HOSPITAL INC | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92240 | $261.64 | 1932309325 - MEHDI QALBANI | 852340442 | 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 92240 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92240 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 92240 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 |
|---|---|---|
| 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) |
| 92229-CPT | Low | Imaging Of Retina For Detection Or Monitoring Of Disease; Point-Of-Care Autonomous Analysis And Report Unilateral Or Bilateral (Desc Rvsd 1/1/23) |
| 92235-CPT | Low | Fluorescein Angiography (Includes Multiframe Imaging) With Interpretation And Report Unilateral Or Bilateral. (Desc Revised 1/1/2017) |
| 92240-CPT | Moderate | Indocyanine-Green Angiography (Includes Multiframeimaging) With Interpretation And Report Unilateraunilateral 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 92240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92240 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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