CPT 92313 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 |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Low |
National average reimbursement for CPT 92313 by major payers:
$109.08
$113.72
$120.51
$153.05
| 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 92313 | ||||||
United | 92313 | $48.27 | 1285834440 - LARON PHILLIPS | 842494027 - BRIGHTSIDE MEDICAL | CO | Psychiatry Physician (2084P0800X) |
United | 92313 | $121.93 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 92313 | $116.48 | 1851558001 - LUBOV ROMANTSEVA | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92313 | $247.13 | 1104230036 - AFSANEH TALAI | 756002868 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92313 | $205.72 | 1417900168 - SUNILA OCONNOR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92313 | $165.08 | 1851376230 - ANITA PAIRITZ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 92313 | $92.86 | 1922328426 - MAJED DALLOUL | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Psychiatry Physician (2084P0800X) |
United | 92313 | $166.11 | 1609239243 - MEGAN GINSBURG | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 92313 | $121.79 | 1700175783 - MY PHON NGUYEN | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 92313 | $168.28 | 1942400924 - KATHERINE JOHNSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 92313 | $123.81 | 1376040014 - JODY WONG | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 92313 | $48.27 | 1285834440 - LARON PHILLIPS | 842494027 - BRIGHTSIDE MEDICAL | KS | Psychiatry Physician (2084P0800X) |
United | 92313 | $137.49 | 1629046735 - AQEEL KHAN | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 92313 | $184.19 | 1144267865 - NITIN PATEL | 364143823 - SIU PHYSICIANS & SURGEONS INC | MO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92313 | $131.52 | 1679526784 - ELTON SMITH | 911031583 | NC | 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 92313 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92313 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 92313 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 92313. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92313 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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