CPT 92613 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 • GN - Services delivered under an outpatient speech language pathology plan of care • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 92613 |
National average reimbursement for CPT 92613 by major payers:
$56.19
$49.45
$49.32
$60.52
| 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 92613 | ||||||
United | 92613 | $59.90 | 1689622029 - TERESA SRIPADA | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 92613 | $64.11 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 92613 | $34.84 | 1184298713 - TIFFANY VUONG | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 92613 | $64.19 | 1558620146 - RAUNAK KHISTY | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 92613 | $44.65 | 1508922964 - COLLEEN BUHRFIEND | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92613 | $44.27 | 1417480625 - ELIZABETH WHITHAM | 330633863 | CA | Psychiatry Physician (2084P0800X) |
United | 92613 | $43.24 | 1215597554 - MATTEO RESPINO | 351747218 - INDIANA UNIVERSITY HEALTH CARE ASSOCIATES INC | IL | Psychiatry Physician (2084P0800X) |
United | 92613 | $43.24 | 1851376230 - ANITA PAIRITZ | 351913875 - INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS | IL | Psychiatry Physician (2084P0800X) |
United | 92613 | $74.01 | 1942494018 - SANTOSH SHRESTHA | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Psychiatry Physician (2084P0800X) |
United | 92613 | $111.70 | 1295991701 - TRILOK SHAH | 391127163 - ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC | WI | Psychiatry Physician (2084P0800X) |
United | 92613 | $71.41 | 1932130325 - ELIZABETH BERRY-KRAVIS | 911780120 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92613 | $73.29 | 1306340880 - GEORGE GIANAKAKOS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | FL | Psychiatry Physician (2084P0800X) |
United | 92613 | $55.31 | 1225211600 - JOHN MILLICHAP | 454158203 - COMMUNITY CARE NETWORK INC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 92613 | $38.09 | 1366437493 - GEORGE KARTALIAN, JR. | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Surgery Physician (207X00000X) |
United | 92613 | $84.12 | 1205213261 - TAMAR CACERES | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurodevelopmental Disabilities Physician (2084P0005X) |
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 92613 vs. Other Special Otorhinolaryngologic Services and Procedures Codes
The CPT 92613 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 92613 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 |
|---|---|---|
| 92610-CPT | Low | Evaluation Of Oral And Pharyngeal Swallowing Function |
| 92611-CPT | Low | Motion Fluoroscopic Evaluation Of Swallowing Function By Cine Or Video Recording |
| 92612-CPT | Moderate | Flexible Endoscopic Evaluation Of Swallowing By Cine Or Video Recording; (Desc Revised 1/1/2017) |
| 92613-CPT | Low | Flexible Endoscopic Evaluation Of Swallowing By Cine Or Video Recording; Interpretation And Reportonly. (Desc Revised 1/1/2017) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92613. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92613 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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