CPT 92938 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 • Cardiovascular Procedures |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LC - Left circumflex coronary artery • LD - Left anterior descending coronary artery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 92938 |
National average reimbursement for CPT 92938 by major payers:
$575.34
$301.71
$349.10
$7,548.97
| 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 92938 | ||||||
United | 92938 | $19833.00 | 1104887199 - UNIVERSITY PHYSICIANS HEALTHCARE, UNIVERSITY PHYSICIANS HOSPITAL @ KINO | 901074558 | AZ | General Acute Care Hospital (282N00000X) |
United | 92938 | $24709.00 | 1013080084 - ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC, PROVIDENCE QUEEN OF THE VALLEY MEDICAL CENTER | 814791043 - (CA) ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC | CA | General Acute Care Hospital (282N00000X) |
United | 92938 | $12700.00 | 1164539730 - ADVOCATE HEALTH AND HOSPITALS CORPORATION, ADVOCATE LUTHERAN GENERAL HOSPITAL | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | General Acute Care Hospital (282N00000X) |
United | 92938 | $1679.00 | 1134126659 - CALDWELL MEMORIAL HOSPITAL INC | 720878037 - (LA) CALDWELL MEMORIAL HOSPITAL INC | LA | General Acute Care Hospital (282N00000X) |
United | 92938 | $11884.00 | 1124518113 - UCH-MHS, UCHEALTH EMERGENCY ROOM - POWERS | 460796114 - (CO) UCH-MHS | CO | General Acute Care Hospital (282N00000X) |
United | 92938 | $5207.00 | 1083616221 - OKMULGEE MEMORIAL HOSPITAL, INC, OKMULGEE MEMORIAL HOSPITAL | 731357965 - MUSCOGEE (CREEK) NATION DEPARTMENT OF HEALTH | OK | General Acute Care Hospital (282N00000X) |
United | 92938 | $8467.00 | 1013994359 - FAIRVIEW HEALTH SERVICES, UNIVERSITY OF MN MEDICAL CENTER, FAIRVIEW | 410991680 - FAIRVIEW HEALTH SERVICES | MN | General Acute Care Hospital (282N00000X) |
United | 92938 | $16587.00 | 1841843455 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE EMERGENCY ROOM MONTWOOD | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 92938 | $8174.00 | 1083644579 - BRONSON BATTLE CREEK HOSPITAL | 382776791 - (MI) BRONSON BATTLE CREEK HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 92938 | $14716.00 | 1467560128 - ADVOCATE HEALTH AND HOSPITALS CORPORATION, ADVOCATE SOUTH SUBURBAN HOSPITAL | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | General Acute Care Hospital (282N00000X) |
United | 92938 | $7887.00 | 1306868682 - CAMDEN GENERAL HOSPITAL, CAMDEN ER | 581884314 - (TN) CAMDEN GENERAL HOSPITAL | TN | General Acute Care Hospital (282N00000X) |
United | 92938 | $65348.00 | 1639108434 - WILLAMETTE FALLS HOSPITAL, PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER | 611659489 | OR | General Acute Care Hospital (282N00000X) |
United | 92938 | $9784.00 | 1194104687 - SMYTH COUNTY COMMUNITY HOSPITAL, CENTER FOR SLEEP DISORDERS AT SCCH | 540794913 - (VA) SMYTH COUNTY COMMUNITY HOSPITAL | VA | General Acute Care Hospital (282N00000X) |
United | 92938 | $9694.00 | 1548640717 - SMYTH COUNTY COMMUNITY HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL REHABILITATION | 540794913 - (VA) SMYTH COUNTY COMMUNITY HOSPITAL | VA | General Acute Care Hospital (282N00000X) |
United | 92938 | $15252.00 | 1205018439 - LAKE POINTE OPERATING COMPANY, LLC, BAYLOR SCOTT & WHITE MEDICAL CENTER LAKE POINTE | 260194016 - (TX) LAKE POINTE OPERATING COMPANY LLC | TX | 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 92938 vs. Other Cardiovascular Procedures Codes
The CPT 92938 code is part of the Medicine Services and Procedures services used for Cardiovascular 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 92938 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 |
|---|---|---|
| 92934-CPT | Moderate | Percutaneous Transluminal Coronary Atherectomy With Intracoronary Stent With Coronary Angioplasty When Performed; Each Additional Branchof A Major Coronary Artery (List Separately In Addition To Code For Primary Procedure) |
| 92937-CPT | Moderate | Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass Graft (Internal Mammary Free Arterial Venous) Any Combination Of Intracoronary Stent Atherectomy And Angioplasty Including Distal Proctection When Performed; Single Vessel |
| 92938-CPT | Moderate | Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass Graft (Internal Mammary Free Arterial Venous) Any Combination Of Intracoronary Stent Atherectomy And Angioplasty Including Distal Protection When Performed; Each Additional Branch Subtended By Thebypass Graft (List Separately In Addition To Code For Primary Procedure) |
| 92941-CPT | Moderate | Percutaneous Transluminal Revascularization Of Acute Total/Subtotal Occlusion During Acute Myocardial Infarction Coronary Artery Or Coronaryartery Bypass Graft Any Combination Of Intracoronary Stent Atherectomy And Angioplasty Including Aspiration Thrombectomy When Performed Single Vessel |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92938. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92938 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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