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See a sample rate comparisonCPT 92342 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.
Fit Of Spectacl Excpt For Aphakia; Multifoca Other Than Bifo, Fitting Of Spectacles Except For Aphakia; Multifocal Other Than Bifo
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | KX - Requirements specified in the medical policy have been met 75 |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 92342 |
| Medicaid Fee Schedule | $33.13 median of the 8 states in the free preview · View Medicaid rates for 92342 |
National average reimbursement for CPT 92342 by major payers:
$53.09
$53.13
$48.48
$45.03
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CPT 92342
5 of 25 sample ratesHigher to lower in this preview
John Millichap
Warren Clinic Inc
$108.30Published rateLara Segalite
Advocate Health And Hospitals Corporation
$80.18Published rateAbby Fredrickson
Loyola University Medical Center
$75.36Published rateNina Liu
Northshore University Healthsystem Faculty Practice Associates
$61.93Published rateLeanne Mcnabney
Town Center Orthopaedic Associates, P.C.
$44.89Published rate
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See a sample payer proposalCPT 92342 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92342 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 92342 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 |
|---|---|---|
| 92340-CPT | Low | Fit Spectacle,Not Aphakia;Monofocal |
| 92341-CPT | Low | Fit Spectacles,Not Aphakia; Bifocal |
| 92342-CPT | Low | Fit Of Spectacl Excpt For Aphakia; Multifoca Other Than Bifo, Fitting Of Spectacles Except For Aphakia; Multifocal Other Than Bifo |
| 92352-CPT | Low | Fitting For Eyeglasses, Fitting Of An Eyeglass Worn To Correct A Condition Where The Natural Lens Of A Persons Eye Is Missing (Aphakia). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92342 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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