CPT 92242 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 26 - Professional component RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 92242 |
National average reimbursement for CPT 92242 by major payers:
$298.95
$288.53
$298.89
$410.82
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 92242 | $302.70 | 1053358978 - EDWARD QUINLAN | 860708606 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $194.58 | 1144304213 - SHAUN BRIERLY | 860423068 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $44.65 | 1053482554 - NEAL NIRENBERG | 861029683 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $44.65 | 1245224211 - ROBERT MCCULLOCH | 860844046 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $236.80 | 1033167093 - ROBERT RUMMEL | 860695546 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $164.22 | 1770549719 - WARREN VICTOR | 860518197 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $194.58 | 1598758898 - WILLIAM MCLEISH | 860930581 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $51.81 | 1003808809 - SHARAM DANESH | 272077432 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $95.51 | 1881686558 - JOSEPH BRYAN | 721561134 | AZ | Retina Specialist (Ophthalmology) Physician (207WX0107X) |
United | 92242 | $55.58 | 1285672345 - ANIKA GOODWIN | 882517801 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $399.42 | 1477532497 - MARTIN WORRALL | 942958258 | AZ | Retina Specialist (Ophthalmology) Physician (207WX0107X) |
United | 92242 | $61.22 | 1245224211 - ROBERT MCCULLOCH | 860844046 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $65.94 | 1821298134 - SHAMIL PATEL | 860695952 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $224.00 | 1851387344 - JAMES KOSTER | 860324400 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $233.83 | 1356402523 - THERESA KRAMER | 522102537 | AZ | 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 92242 vs. Other Special Ophthalmological Services and Procedures Codes
The CPT 92242 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 92242 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 | 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. |
| 92242-CPT | Moderate | Fluorescein Angiography And In, Fluorescein Angiography And Indocyanine-Green Angiography (Includes Multiframe Imaging) Performed Atthe Same Patient Encounter With Interpretation An D 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 92242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92242 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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