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See a sample rate comparisonCPT 92516 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.
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| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Otorhinolaryngologic Services and Procedures |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | $75.15 national non-facility rate (2026) · View Medicare rates for 92516 |
| Medicaid Fee Schedule | $59.49 median of the 8 states in the free preview · View Medicaid rates for 92516 |
National average reimbursement for CPT 92516 by major payers:
$80.85
$85.00
$89.18
$44.60
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CPT 92516
5 of 25 sample ratesHigher to lower in this preview
Afsaneh Talai
$173.07Published rateCynthia Gordon
Illinois Professionals Health Progr
$142.64Published rateLuda Sorin
West Virginia University Medical Corporation
$120.73Published ratePaul Berkowitz
Presence Healthcare Services
$89.61Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$24.86Published rate
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See a sample payer proposalCPT 92516 vs. Other Special Otorhinolaryngologic Services and Procedures Codes
The CPT 92516 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 92516 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92516 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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