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See a sample rate comparisonCPT 92310 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.
Prescription Of Optical And Ph, Prescription Of Optical And Physical Characteristics Of And Fitting Of Contact Lens With Medical Supervision Of Adaptation Corneal Lens Both Eyesexcept For Aphakia
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | ND - Skilled nursing facility to Diagnostic site 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 92310 |
| Medicaid Fee Schedule | $77.995 median of the 8 states in the free preview · View Medicaid rates for 92310 |
National average reimbursement for CPT 92310 by major payers:
$115.27
$117.64
$119.49
$151.68
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CPT 92310
5 of 25 sample ratesHigher to lower in this preview
Janelle Park
Dartmouth-Hitchcock Clinic
$388.39Published rateSamantha Barry
Dartmouth-Hitchcock Clinic
$385.39Published ratePaul Steiner
Dartmouth-Hitchcock Clinic
$246.60Published rateDavid Court
Dartmouth-Hitchcock Clinic
$246.60Published rateNoeline Rajarajan
St Agnes Healthcare Inc
$110.79Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 92310 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92310 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 92310 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 |
|---|---|---|
| 92310-CPT | Low | Prescription Of Optical And Ph, Prescription Of Optical And Physical Characteristics Of And Fitting Of Contact Lens With Medical Supervision Of Adaptation Corneal Lens Both Eyesexcept For Aphakia |
| 92311-CPT | Low | Prescription Of Optical And Ph, Prescription Of Optical And Physical Characteristics Of And Fitting Of Contact Lens With Medical Supervision Of Adaptation Corneal Lens For Aphakia One Eye |
| 92312-CPT | Low | Contact Lens Fitg Aphakia Ou, Prescription Of Optical And Physical Characteristics Of And Fitting Of Contact Lens With Medical Supervision Of Adaptation Corneal Lens For Aphakia Both Eyes |
| 92313-CPT | Low | Prescription Of Optical And Ph, Prescription Of Optical And Physical Characteristics Of And Fitting Of Contact Lens With Medical Supervision Of Adaptation Corneoscleral Lens |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92310. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92310 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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Frequently Asked Questions
To find the cost of a specific medical procedure, you should ideally contact your healthcare provider directly and your insurance company. They can often provide an estimate. For a more comprehensive search based on CPT codes and your specific location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows you to search with CPT codes and specific locations to get an idea of potential costs.
CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare professionals to describe medical, surgical, and diagnostic services. They are crucial for understanding medical costs because they are the basis for billing and reimbursement. When searching for procedure costs, knowing the CPT code helps you get accurate and comparable price information, especially when using tools like Payerprice.
Prices for the same medical procedure can vary significantly due to several factors, including the type of facility (hospital vs. outpatient clinic), geographical location, the provider's reputation or specialty, negotiated rates with different insurance companies, and the complexity of the patient's individual case. Each healthcare provider sets their own "chargemaster" prices, and insurance companies then negotiate different rates, leading to wide variations in what patients ultimately pay or what is billed.
Your insurance significantly impacts the final cost you pay. Most insurance plans have deductibles, co-pays, and co-insurance. A deductible is the amount you must pay out-of-pocket before your insurance starts to cover costs. A co-pay is a fixed amount you pay for a service at the time of visit. Co-insurance is a percentage of the cost you pay after your deductible is met. The specific terms of your plan dictate how much of a procedure's cost will be covered by insurance versus what you owe. Always check with your insurance provider for details specific to your plan and coverage.
For a detailed fee schedule of medical procedures based on CPT codes and your specific location, you can use specialized tools. Payerprice offers a fee schedule lookup tool where you can search with CPT codes and specific geographical areas to find relevant pricing information. This can help you understand the potential costs of various procedures in your region.