CPT 92986 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | High |
National average reimbursement for CPT 92986 by major payers:
$1,675.81
$1,786.64
$1,833.96
$2,131.92
| 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 92986 | ||||||
United | 92986 | $1307.44 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
United | 92986 | $1600.42 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | 92986 | $8827.05 | 1215903018 - COMMUNITY MEMORIAL HEALTH SYSTEM, COMMUNITY MEMORIAL HOSPITAL OF SAN BUENA VENTURA | 951683892 - COMMUNITY MEMORIAL HEALTH SYSTEM | CA | General Acute Care Hospital (282N00000X) |
United | 92986 | $10214.00 | 1053447086 - JANE PHILLIPS NOWATA HEALTH CENTER | 731440267 - (OK) JANE PHILLIPS NOWATA HEALTH CENTER | OK | Critical Access Hospital (282NC0060X) |
United | 92986 | $1172.00 | 1548233794 - METAIRIE OPHTHALMOLOGY ASC LLC, AMBULATORY EYE SURGERY CENTER OF LOUISIANA | 621822003 - (LA) THE METAIRIE OPHTHALMOLOGY ASC, LLC DBA AMBULATORY EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 92986 | $7212.00 | 1427049964 - KERN VALLEY HEALTHCARE DISTRICT | 956142366 - (CA) KERN VALLEY HEALTHCARE DISTRICT | CA | Critical Access Hospital (282NC0060X) |
United | 92986 | $19308.00 | 1194122390 - PROVIDENCE ST. VINCENT MEDICAL CENTER | 930386929 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | General Acute Care Hospital (282N00000X) |
United | 92986 | $30091.00 | 1659330173 - MERCY MEDICAL CENTER | 111635088 - (NY) MERCY MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 92986 | $1000.00 | 1063435782 - SOUTHWEST HEALTH CORP., HOSPITAL METROPOLITANO DE SAN GERMAN | 660558678 - (PR) SOUTHWEST HEALTH CORPORATION (HOSPI TAL SAN GERMAN, CABO ROJO, ARECIBO | PR | General Acute Care Hospital (282N00000X) |
United | 92986 | $5475.00 | 1164876546 - BBH PBMC, LLC, PRINCETON BAPTIST MEDICAL CENTER | 474775351 | AL | General Acute Care Hospital (282N00000X) |
United | 92986 | $16472.00 | 1699002527 - CARDINAL GLENNON CHILDREN'S HOSPITAL | 430738490 - SSM HEALTH CARDINAL GLENNON CHILDRENS HOSPITAL | MO | Children's Hospital (282NC2000X) |
United | 92986 | $1168.06 | 1255449807 - BEAUMONT MRI INC, AMERICAN HEALTH IMAGING OF BEAUMONT | 412056531 - (TX) BEAUMONT MRI INC | TX | Radiology Clinic/Center (261QR0200X) |
United | 92986 | $1232.95 | 1568615094 - LOUDOUN IMAGING CENTER/ASHBURN, LLC | 263615091 | VA | Radiology Clinic/Center (261QR0200X) |
United | 92986 | $1679.00 | 1134126659 - CALDWELL MEMORIAL HOSPITAL INC | 720878037 - (LA) CALDWELL MEMORIAL HOSPITAL INC | LA | General Acute Care Hospital (282N00000X) |
United | 92986 | $30958.00 | 1497765630 - ST. CHARLES HOSPITAL CORP. | 111871039 - (NY) ST CHARLES HOSPITAL CORP | NY | 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 92986 vs. Other Cardiovascular Procedures Codes
The CPT 92986 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 92986 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 92986. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92986 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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