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See a sample rate comparisonCPT 92504 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.
Binocular Microscopy
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Otorhinolaryngologic Services and Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $28.73 national non-facility rate (2026) · View Medicare rates for 92504 |
| Medicaid Fee Schedule | $23.055 median of the 8 states in the free preview · View Medicaid rates for 92504 |
National average reimbursement for CPT 92504 by major payers:
$33.59
$36.67
$40.44
$19.34
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CPT 92504
5 of 25 sample ratesHigher to lower in this preview
Diana Sieciechowicz
Pediatric Faculty Foundation In
$65.75Published rateColleen Buhrfiend
$53.38Published ratePatricia Mumby
Loyola University Medical Center
$47.22Published rateJohn Millichap
$40.24Published rateChristopher Lombardi
$11.84Published rate
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See a sample payer proposalCPT 92504 vs. Other Special Otorhinolaryngologic Services and Procedures Codes
The CPT 92504 code is part of the Medicine Services and Procedures services used for Special Otorhinolaryngologic 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 92504 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 |
|---|---|---|
| 92502-CPT | Low | Otolaryngologic Exam - Gen.Anesth |
| 92504-CPT | Low | Binocular Microscopy |
| 92511-CPT | Low | Nasopharyngoscopy With Endoscope |
| 92512-CPT | Low | Test To Evaluate Nose Function, Testing Of Nose Functions (Rhinomanometry). The Physician May Use Sound Or A Pressure Sensor Inside The Nose. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92504. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92504 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a standardized set of medical codes used by healthcare providers, facilities, and insurers to describe and bill for medical, surgical, and diagnostic services performed on patients. They are essential for accurate billing and for communicating the services provided.
To find the cost of a specific medical procedure or service, you will typically need its CPT code. Once you have the CPT code, you can use online fee schedule lookup tools or directly contact providers and your insurance company. For specific fee schedule information tailored to your location, Payerprice offers a tool to search with CPT codes.
A fee schedule is a comprehensive list of fees that outlines the maximum allowable amounts that health insurers or government programs will reimburse providers for specific medical services, procedures, or drugs. It is crucial for understanding potential costs, for providers to bill correctly, and for payers to manage healthcare expenditures efficiently.
You use a CPT code as a unique identifier for a specific medical service. You can enter this code into a fee schedule lookup tool, like the one provided by Payerprice, along with your specific geographic location. The tool will then provide estimated costs or reimbursement rates associated with that CPT code in your area.
For reliable and specific pricing information for healthcare services based on CPT codes and your geographic location, it is recommended to use a specialized fee schedule lookup tool. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to find relevant pricing data, helping you understand potential costs before receiving care.
A fee schedule typically shows the provider's charge or the insurer's contracted reimbursement rate, but it does not directly determine your out-of-pocket cost. Your actual coverage and financial responsibility will depend on your specific insurance plan's benefits, including your deductible, copayments, coinsurance, and whether the provider is in-network. Always contact your insurance provider directly for details on your specific plan's coverage for any CPT code.