CPT 92312 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 • 19 - Off Campus Outpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • KX - Requirements specified in the medical policy have been met • SC - Medically necessary service or supply |
| Complexity Level | Low |
National average reimbursement for CPT 92312 by major payers:
$136.28
$137.47
$136.61
$187.45
| 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 92312 | ||||||
United | 92312 | $205.27 | 1760778468 - NATHAN ONTROP | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 92312 | $155.44 | 1225211600 - JOHN MILLICHAP | 753186720 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92312 | $204.88 | 1477074060 - OLATOLA IYI-OJO | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 92312 | $255.33 | 1821097924 - AFTAB POSHNI | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 92312 | $204.00 | 1679968697 - JEREMIAH BREWER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 92312 | $321.97 | 1851490791 - TANYA ROYSTER | 371206525 - QUINCY PHYSICIANS & SURGEONS CLINIC S.C. D/B/A QUINCY MEDICAL GROUP | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92312 | $210.77 | 1891921367 - KAVITA THAKKAR | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92312 | $301.17 | 1225211600 - JOHN MILLICHAP | 731310891 - WARREN CLINIC INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92312 | $204.00 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 92312 | $189.47 | 1568752665 - ANDREW KNOX | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92312 | $217.05 | 1841721925 - CHELSEA CURRY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 92312 | $171.52 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 92312 | $220.58 | 1508922964 - COLLEEN BUHRFIEND | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92312 | $179.86 | 1487841540 - CEZARY DUDZINSKI | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 92312 | $217.05 | 1255534483 - SHALINI CHAWLA | 274089658 - (IL) SHALINI CHAWLA MD LLC | 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 92312 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92312 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 92312 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 Physical Characteristics Of And Fitting Of Contact Lens, With Medical Supervision Of Adaptation; Corneal Lens, Both Eyes, Except For Aphakia |
| 92311-CPT | Low | Prescription Of Optical And Physical Characteristics Of And Fitting Of Contact Lens, With Medical Supervision Of Adaptation; Corneal Lens For Aphakia, 1 Eye |
| 92312-CPT | Low | 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 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 92312. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92312 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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