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See a sample rate comparisonCPT 92250 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.
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| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 52 - Reduced Services |
| Complexity Level | Low |
| Medicare Fee Schedule | $37.08 national non-facility rate (2026) · View Medicare rates for 92250 |
| Medicaid Fee Schedule | $30.625 median of the 8 states in the free preview · View Medicaid rates for 92250 |
National average reimbursement for CPT 92250 by major payers:
$61.27
$69.50
$67.44
$78.02
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CPT 92250
5 of 25 sample ratesHigher to lower in this preview
Randoll Christopher
University Medical Service Association Inc
$92.62Published ratePete Peterson
Tampa Bay Surgical Group, LLP
$47.43Published rateJeffrey Smith
Orlando Health Medical Group Inc
$27.21Published rateLarry Nicholson
Larry Lee Nicholson II Od
$19.26Published rateOphthalmic Consultant Of New York, PLLC
Ophthalmic Consultant Of New York PLLC
$10.71Published rate
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See a sample payer proposalCPT 92250 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92250 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 92250 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 |
|---|---|---|
| 92230-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. |
| 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. |
| 92240-CPT | Moderate | 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. |
| 92250-CPT | Low | Fundus Photography With Interp, Fundus Photography With Interpretation And Reportfundus Photography With Interpretation And Report |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92250 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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