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See a sample rate comparisonCPT 92358 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.
Prosthes Svc For Aphakia Temp (Disposable Or Loan Includ, Prosthesis Service For Aphakia Temporary (Disposable Or Loan Includi
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Ophthalmology Services and Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | RT - Right side of body 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 92358 |
| Medicaid Fee Schedule | $18.165 median of the 8 states in the free preview · View Medicaid rates for 92358 |
National average reimbursement for CPT 92358 by major payers:
$21.15
$18.37
$14.07
$22.43
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CPT 92358
5 of 25 sample ratesHigher to lower in this preview
Laura Vernon
Pediatric Faculty Foundation In
$35.59Published rateMusaddiq Tariq
Loyola University Medical Center
$19.45Published rateMy Phon Nguyen
Mount Sinai Community Foundation
$16.72Published ratePaul Berkowitz
Presence Healthcare Services
$14.31Published rateNarsimha Muddasani
Touchette Regional Hospital Inc
$9.65Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 92358 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92358 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 92358 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 |
|---|---|---|
| 92353-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). |
| 92354-CPT | Low | Fit Of Spectacl Mounted Low Vision Aid; Sngle Element System, Fitting Of Spectacle Mounted Low Vision Aid; Single Element System |
| 92355-CPT | Low | Fit Of Spectacl Mounted Low Vision Aid; Telscopic Or Other Comp, Fitting Of Spectacle Mounted Low Vision Aid; Telescopic Or Other Compo |
| 92358-CPT | Low | Prosthes Svc For Aphakia Temp (Disposable Or Loan Includ, Prosthesis Service For Aphakia Temporary (Disposable Or Loan Includi |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92358. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92358 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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