CPT 92315
Global XXX ActiveC-lens fitg tech aphakia 1
CPT 92315 Billing & Documentation Guide
CPT code 92315 (C-lens fitg tech aphakia 1) is classified under Ophthalmology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.44, a non-facility practice expense RVU of 1.92, and a malpractice RVU of 0.01, a total non-facility RVU of 2.37 and facility RVU of 0.53. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $82.21, though rates vary from $69.96 to $108.97 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92315, 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 92315 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 92315 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 92315
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.44 | 0.44 |
| Practice Expense RVU | 1.92 | 0.08 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 2.37 | 0.53 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92315
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 | $91.29 | $18.56 | $85.41 - $108.97 | 29 |
| Florida | $79.69 | $18.03 | $76.51 - $82.3 | 3 |
| Georgia | $76.3 | $17.67 | $72.3 - $80.3 | 2 |
| Illinois | $77.35 | $17.97 | $73.77 - $81.25 | 4 |
| Michigan | $75.38 | $17.68 | $73.62 - $77.14 | 2 |
| North Carolina | $74.74 | $17.4 | $74.74 - $74.74 | 1 |
| New York | $87.39 | $18.83 | $75.85 - $92.51 | 5 |
| Ohio | $73.58 | $17.47 | $73.58 - $73.58 | 1 |
| Pennsylvania | $78 | $17.8 | $73.88 - $82.12 | 2 |
| Texas | $78.22 | $17.72 | $73.36 - $82.87 | 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 92315
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92315 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 | Yes | CPT Separate procedure 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 |
| 99205 | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 99211 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 92315
What does CPT code 92315 mean? +
CPT code 92315 represents: C-lens fitg tech aphakia 1. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92315? +
The 2026 Medicare national average non-facility payment for CPT 92315 is $82.21. Rates range from $69.96 to $108.97 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92315? +
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 92315? +
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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