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 | • 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 92242 by major payers:
$298.95
$288.53
$298.89
$420.46
| 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 92242 | ||||||
United | 92242 | $53.90 | 1013353804 - RIMA PATEL | 860285158 | AZ | Retina Specialist (Ophthalmology) Physician (207WX0107X) |
United | 92242 | $169.05 | 1235124744 - PATRICK AIELLO | 900424263 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $164.22 | 1770549719 - WARREN VICTOR | 860518197 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $149.92 | 1003808809 - SHARAM DANESH | 272077432 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $302.70 | 1053358978 - EDWARD QUINLAN | 860708606 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $248.27 | 1467418194 - DANIEL SCHICKNER | 860932232 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $233.83 | 1356402523 - THERESA KRAMER | 522102537 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $169.05 | 1851317861 - BARNET DULANEY PERKINS EYE CENTER, PC, AMERICAN VISION PARTNERS | 860852485 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $348.22 | 1447516133 - AMIT SANGAVE | 381357020 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $256.00 | 1376574707 - BARNET DULANEY PERKINS EYE CENTER, PC, AMERICAN VISION PARTNERS | 860852485 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $194.58 | 1770549719 - WARREN VICTOR | 860423068 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $1297.31 | 1699902577 - SUJIT ITTY | 954379486 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $44.65 | 1295799369 - AJAY SANAN | 421543373 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $414.60 | 1982107702 - JOSEPH JULIANO | 822784244 | AZ | Ophthalmology Physician (207W00000X) |
United | 92242 | $54.95 | 1356488175 - NORTHWEST EYE SPECIALISTS L L C | 860720868 | 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 Ophthalmology Services and Procedures Codes
The CPT 92242 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 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 | 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) |
| 92242-CPT | Moderate | Fluorescein Angiography And Indocyanine-Green Angiography (Includes Multiframe Imaging) Performed At The Same Patient Encounter With Interpretation And 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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