CPT 92499 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 |
| Common Modifiers | • None • EP - Residential facility to Physician's office • GA - Required ABN issued and on file |
| Complexity Level | Moderate |
National average reimbursement for CPT 92499 by major payers:
$712.77
$92.12
$3,750.12
$568.20
| 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 92499 | ||||||
United | 92499 | $92.22 | 1447406699 - FRANCISCAN HEALTH SYSTEM, ST ANTHONY HOSPITAL | 383769889 | WA | General Acute Care Hospital (282N00000X) |
United | 92499 | $62.90 | 1598905762 - CENTRAL IOWA HOSPITAL CORPORATION, UNITYPOINT HEALTH - DES MOINES IOWA METHODIST MEDICAL CENTER | 420680452 - CENTRAL IOWA HOSPITAL CORPORATION | IA | General Acute Care Hospital (282N00000X) |
United | 92499 | $103.29 | 1609807122 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | General Acute Care Hospital (282N00000X) |
United | 92499 | $42.58 | 1568848059 - CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC, LEGENT ORTHOPEDIC & SPINE | 474612520 | TX | General Acute Care Hospital (282N00000X) |
United | 92499 | $60.43 | 1851344907 - NORTH MEMORIAL HEALTH CARE, NORTH MEMORIAL HEALTH HOSPITAL | 410729979 - NORTH MEMORIAL HEALTH CARE | MN | General Acute Care Hospital (282N00000X) |
United | 92499 | $86.80 | 1790734127 - SAINT FRANCIS MEDICAL CENTER, CHILDREN'S HOSPITAL OF ILLINOIS | 370662569 - (IL) SAINT FRANCIS MEDICAL CENTER | IL | Children's Hospital (282NC2000X) |
United | 92499 | $126.70 | 1255327201 - MULTICARE HEALTH SYSTEM, MULTICARE AUBURN MEDICAL CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 92499 | $65.48 | 1598971855 - OVERLAKE HOSPITAL MEDICAL CENTER LAB | 910652651 - (WA) OVERLAKE HOSPITAL MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 92499 | $36.84 | 1487651857 - OKLAHOMA SURGICAL HOSPITAL, LLC | 731573733 - (OK) OKLAHOMA SURGICAL HOSPITAL LLC | OK | General Acute Care Hospital (282N00000X) |
United | 92499 | $103.29 | 1609807122 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | General Acute Care Hospital (282N00000X) |
United | 92499 | $37.36 | 1134222565 - LAFAYETTE SURGICAL HOSPITAL LLC, LAFAYETTE SURGICAL SPECIALTY HOSPITAL | 900021727 - (LA) LAFAYETTE SURGICAL HOSPITAL LLC | LA | General Acute Care Hospital (282N00000X) |
United | 92499 | $96.41 | 1720371487 - SIBLEY MEMORIAL HOSPITAL | 530196602 - (DC) LUCY WEBB HAYNES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSION | DC | General Acute Care Hospital (282N00000X) |
United | 92499 | $74.44 | 1588269898 - WEST PENN ALLEGHENY HEALTH SYSTEM, INC, AHN WEXFORD HOSPITAL | 250969492 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 92499 | $71.41 | 1215598156 - AHN EMERUS WESTMORELAND LLC, AHN BRENTWOOD NEIGHBORHOOD HOSPITAL | 823697883 - (PA) AHN EMERUS WESTMORELAND LLC | PA | General Acute Care Hospital (282N00000X) |
United | 92499 | $168.58 | 1073510277 - PEACEHEALTH, ST. JOHN MEDICAL CENTER | 910564987 | WA | General Acute Care Hospital (282N00000X) |
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 92499 vs. Other Ophthalmology Services and Procedures Codes
The CPT 92499 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 92499 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 |
|---|---|---|
| 92285-CPT | Low | External Ocular Photography With Interpretation And Report For Documentation Of Medical Progress (Eg, Close-Up Photography, Slit Lamp Photography, Goniophotography, Stereo-Photography) |
| 92286-CPT | Low | Anterior Segment Imaging With Interpretation And And Report; With Specular Microscopy And Endo- Thelial And Cell Analysis (Revised 1/1/13) |
| 92354-CPT | Low | Fit Spect-Low Vision Aid;1 El.Systm |
| 92499-CPT | Moderate | Unlisted Ophthalmological Service Or Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92499 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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