CPT 92312
Global XXX ActiveContact lens fitg aphakia ou
CPT 92312 Billing & Documentation Guide
CPT code 92312 (Contact lens fitg aphakia ou) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.23, a non-facility practice expense RVU of 2.15, and a malpractice RVU of 0.01, a total non-facility RVU of 3.39 and facility RVU of 1.47. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $117.15, though rates vary from $102.94 to $149.33 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92312, 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 92312 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 92312 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 92312
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.23 | 1.23 |
| Practice Expense RVU | 2.15 | 0.23 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 3.39 | 1.47 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92312
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 | $127.71 | $51.83 | $120.67 - $149.33 | 29 |
| Florida | $113.78 | $49.44 | $110.24 - $116.68 | 3 |
| Georgia | $110.06 | $48.87 | $105.54 - $114.57 | 2 |
| Illinois | $111.25 | $49.29 | $107.17 - $115.71 | 4 |
| Michigan | $108.98 | $48.77 | $107.02 - $110.94 | 2 |
| North Carolina | $108.3 | $48.46 | $108.3 - $108.3 | 1 |
| New York | $123.6 | $52.06 | $109.54 - $129.72 | 5 |
| Ohio | $106.98 | $48.43 | $106.98 - $106.98 | 1 |
| Pennsylvania | $112.15 | $49.34 | $107.32 - $116.98 | 2 |
| Texas | $112.32 | $49.18 | $106.74 - $117.44 | 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 92312
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92312 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 |
| 92325 | Column 1 (primary), can be billed with modifier | No | 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 |
| 99204 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 92312
What does CPT code 92312 mean? +
CPT code 92312 represents: Contact lens fitg aphakia ou. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92312? +
The 2026 Medicare national average non-facility payment for CPT 92312 is $117.15. Rates range from $102.94 to $149.33 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92312? +
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 92312? +
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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