CPT 92538 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 • Special Otorhinolaryngologic Services and Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 92538 by major payers:
$26.59
$28.10
$28.64
$43.62
| 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 92538 | ||||||
United | 92538 | $14.56 | 1548366263 - NARSIMHA MUDDASANI | 371305510 - TOUCHETTE REGIONAL HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 92538 | $6.71 | 1568705622 - IUNIA DADARLAT | 352030653 - ARNETT CLINIC LLC | IN | Psychiatry Physician (2084P0800X) |
United | 92538 | $7.57 | 1639111248 - ROBERT EGEL | 363155454 - (IL) ROBERT T EGEL M D S C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $10.22 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $5.65 | 1134127301 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 92538 | $43.88 | 1336431667 - SURAYA KAWADRY | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 92538 | $39.04 | 1477670461 - LOUIS KRAUS | 911780160 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92538 | $4.23 | 1265883375 - JOCELYN LORENZO | 726000821 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $33.06 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $31.46 | 1144203753 - HAIDAR KABBANI | 202305158 - TRIHEALTH G, LLC | OH | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $47.29 | 1790936540 - SRISHTI NANGIA | 131623978 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $22.46 | 1386969079 - ADAM WALLACE | 391678306 - AURORA MEDICAL GROUP INC | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $22.46 | 1386969079 - ADAM WALLACE | 391678306 - AURORA MEDICAL GROUP INC | MN | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92538 | $4.13 | 1205917176 - RANDY JUNG | 371305510 - TOUCHETTE REGIONAL HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 92538 | $6.48 | 1588012058 - ALEXANDRIA MELENDEZ-ZAIDI | 752668018 | TX | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 92538 vs. Other Special Otorhinolaryngologic Services and Procedures Codes
The CPT 92538 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 92538 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 |
|---|---|---|
| 92537-CPT | Low | Caloric Vestibular Test With Recording, Bilateral; Bithermal (Ie, One Warm And One Cool Irrigation In Each Ear For A Total Of Four Irrigations) |
| 92538-CPT | Low | Caloric Vestibular Test With Recording, Bilateral; Monothermal (Ie, One Irrigation In Each Ear For A Total Of Two Irrigations) |
| 92540-CPT | Low | Basic Vestibular Evaluation Includes Spontaneous Nystagmus Test With Eccentric Gaze Fixation Nystagmus With Recording Positional Nystagmus Test Minimum Of 4 Positions With Recording Optokinetic Nystagmus Test Bidirectional Foveal And Peripheral Stimulation With Recording And Oscillating Tracking Test With Recording |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92538 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 92538) and we'll show you how you compare in 15 minutes or less.