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See a sample rate comparisonCPT 92313 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 Corneoscleral Lens
| 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 | RT - Right side of body LT - Left side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | $95.53 national non-facility rate (2026) · View Medicare rates for 92313 |
| Medicaid Fee Schedule | $76.105 median of the 8 states in the free preview · View Medicaid rates for 92313 |
National average reimbursement for CPT 92313 by major payers:
$109.08
$113.72
$120.51
$149.75
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CPT 92313
5 of 25 sample ratesHigher to lower in this preview
Srishti Nangia
$321.27Published rateSunila Oconnor
Pediatric Faculty Foundation In
$205.72Published rateReid Alley
Riverside Health System
$160.44Published rateCorey Goldstein
$123.81Published rateLaron Phillips
Brightside Medical
$48.27Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 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 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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