CPT 92316 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 • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • 26 - Professional component |
| Complexity Level | Low |
National average reimbursement for CPT 92316 by major payers:
$107.83
$110.08
$112.06
$152.46
| 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 92316 | ||||||
United | 92316 | $117.86 | 1730263617 - MARK ALTER | 811324691 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92316 | $168.19 | 1265753867 - ASIFA CHOUDHRY | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IN | Psychiatry Physician (2084P0800X) |
United | 92316 | $32.36 | 1801835202 - CHICAGO NEUROLOGY GROUP SC | 113666848 - (IL) CHICAGO NEUROLOGY GROUP, S.C. | IL | Psychiatry Physician (2084P0800X) |
United | 92316 | $105.12 | 1134741028 - SHAHZAIB KHAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 92316 | $60.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 92316 | $86.66 | 1639111248 - ROBERT EGEL | 363155454 - (IL) ROBERT T EGEL M D S C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92316 | $138.66 | 1063972404 - MAANASA BANDLA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92316 | $40.88 | 1962431726 - MARTINS ADEOYE | 432081789 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92316 | $35.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 92316 | $620.80 | 1760502058 - P. DANIEL LE GRANGE | 943281673 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92316 | $138.66 | 1518318716 - LADAN KHAZAI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 92316 | $175.46 | 1992905335 - PARAG MERAI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92316 | $114.68 | 1275564197 - PAUL BERKOWITZ | 842494027 - BRIGHTSIDE MEDICAL | IN | Psychiatry Physician (2084P0800X) |
United | 92316 | $114.48 | 1588012058 - ALEXANDRIA MELENDEZ-ZAIDI | 752668018 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92316 | $192.10 | 1962664789 - JAMIE EVANS | 910844563 | CA | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 92316 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92316 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 92316 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 |
|---|---|---|
| 92314-CPT | Low | Prescription Of Optical And Physical Characteristics Of Contact Lens, With Medical Supervision Of Adaptation And Direction Of Fitting By Independent Technician; Corneal Lens, Both Eyes Except For Aphakia |
| 92315-CPT | Low | Prescription Of Optical And Physical Characteristics Of Contact Lens, With Medical Supervision Of Adaptation And Direction Of Fitting By Independent Technician; Corneal Lens For Aphakia, 1 Eye |
| 92316-CPT | Low | Prescription Of Optical And Physical Characteristics Of Contact Lens, With Medical Supervision Of Adaptation And Direction Of Fitting By Independent Technician; Corneal Lens For Aphakia, Both Eyes |
| 92317-CPT | Low | Prescription Of Optical And Physical Characteristics Of Contact Lens, With Medical Supervision Of Adaptation And Direction Of Fitting By Independent Technician; 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 92316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92316 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 92316) and we'll show you how you compare in 15 minutes or less.