LOW VISION EXAM 92005 LOW VISION EXAMINATION (SCCB CLINIC) 95.00 ESTABLISHED PATIENT 92012 INTERMEDIATE/RE-EXAM ESTABLISHED PATIENT 52.13 92014 DILATED/INTERMEDIATE EXAM ESTABLISHED PATIENT 76.26 SPECIAL OPHTHALMOLOGICAL SERVICES 92015 DETERMINATION OF REFRACTIVE STATE 24.65 92020 GONIOSCOPY, NOT PART OF COMPLETE EYE EXAM 17.67 92025 26 COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, INTERPRETATION AND REPORT 22.59 13.28 92081 26 VISUAL FIELDS EXAMINATION, UNILATERAL OR BILATERIAL INTREPRETATION 34.59 13.56 92082 26 HUMPHREY VISUAL FIELDS EXAMINATION, INTERMEDIATE INTREPRETATION 45.76 16.58 92083 26 GOLDMANN VISUAL FIELDS EXTENDED EXAM INTREPRETATION 52.29 19.03 92100 SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH MULTIPLE MEASUREMENTS OF INTRAOCULAR PRESSURE 59.01 26 SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING INTERPRETATION 21.47 12.45 92133 26 SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC (OCT) INTREPRETATION 26.41 17.38 92134 26 SCANNING COMPUTERIZED OPHTHALMIC (OCT) INTREPRETATION 26.41 17.38 92136 26 OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH IOL POWER CALCULATION INTREPRETATION 53.91 20.93 CPT CODE DESCRIPTION OF SERVICES FEE
CONTACT LENS FITTING 92313 CORNEOSCLERAL LENS 60.03 FITTING FOR GLASSES FITTING, SPECTACLES EXCEPT FOR APHAKIA, MONOFOCAL 26.53 CONTACT LENS SERVICES (for treatment of eye disease only) LENS SOFT – ONE EYE 125.00 LENS HARD – ONE EYE 150.00 OFFICE VISIT - MEDICAL 99201 INITIAL OFFICE VISIT – EXAM 26.80 99202 INITIAL OFFICE VISIT - EXAM 46.53 99203 INITIAL OFFICE - EXAM 67.37 99204 LEVEL IV MEDICAL EXAM; NEW PATIENT 104.69 99205 GENERAL MEDICAL – HEMOGLOBIN & URINALYSIS 132.41 OFFICE VISIT – ESTABLISHED PATIENT 99211 LEVEL I FOLLOW UP; ESTABLISHED PATIENT 13.52 LEVEL II FOLLOWUP; ESTABLSHED PATIENT 27.05 LEVEL III FOLLOWUP; ESTABLISHED PATIENT 45.37 LEVEL V FOLLOWUP; ESTABLSIHED PATIENT 68.36 99215 LEVEL V FOLLOWUP; ESTABLISHED PATIENT 92.44 INITIAL CONSULTATION 99241 INITIAL OFFICE CONSULTATION 35.45 99242 INITIAL OFFICE CONSULTATION 66.48 99243 INITIAL OFFICE CONSULTATION 91.48 INITIAL OFFICE CONSULTATION 136.16 CPT CODE DESCRIPTION OF SERVICE FEE
ASSESSMENT SERVICES PSYCHIATRIC SERVICES PSYCHIATRIC DIAGNOSTIC EVALUATION 115.38 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES 115.38 PSYCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER 33.87 90833 PSYSCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE OF PRIMARY PROCEDURE) 22.60 90834 PSYCHOTHERAPHY, 45 MINTUES WITH PATIENT AND/OR FAMILY MEMBER 43.95 90836 PSYCHOTHERAPHY, 45 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT OF SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) 36.73 90837 PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER 64.37 90838 PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) 59.13 96101 PHYCHOLOGICAL TESTING – PER HOUR 63.91 MOST FREGUENTLY USED OUTPATIENT FACILITY FEES Outpatient Facility Fees