CPT 92311
Global XXX ActiveContact lens fitg aphakia 1
CPT 92311 Billing & Documentation Guide
CPT code 92311 (Contact lens fitg aphakia 1) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.05, a non-facility practice expense RVU of 1.9, and a malpractice RVU of 0.01, a total non-facility RVU of 2.96 and facility RVU of 1.26. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $102.3, though rates vary from $89.76 to $130.62 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92311, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 92311 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 92311 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 92311
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.05 | 1.05 |
| Practice Expense RVU | 1.9 | 0.2 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 2.96 | 1.26 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92311
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $111.6 | $44.41 | $105.4 - $130.62 | 29 |
| Florida | $99.39 | $42.42 | $96.24 - $101.98 | 3 |
| Georgia | $96.07 | $41.89 | $92.08 - $100.05 | 2 |
| Illinois | $97.15 | $42.29 | $93.53 - $101.08 | 4 |
| Michigan | $95.13 | $41.82 | $93.39 - $96.87 | 2 |
| North Carolina | $94.49 | $41.52 | $94.49 - $94.49 | 1 |
| New York | $107.98 | $44.64 | $95.59 - $113.39 | 5 |
| Ohio | $93.35 | $41.51 | $93.35 - $93.35 | 1 |
| Pennsylvania | $97.9 | $42.29 | $93.64 - $102.16 | 2 |
| Texas | $98.05 | $42.15 | $93.13 - $102.58 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 92311
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92311 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92312 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 92325 | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 92352 | Column 1 (primary), can be billed with modifier | 9 | HCPCS/CPT procedure code definition |
| 92353 | Column 1 (primary), can be billed with modifier | 9 | HCPCS/CPT procedure code definition |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 99201 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 99202 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 99203 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 92311
What does CPT code 92311 mean? +
CPT code 92311 represents: Contact lens fitg aphakia 1. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92311? +
The 2026 Medicare national average non-facility payment for CPT 92311 is $102.3. Rates range from $89.76 to $130.62 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92311? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 92311? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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