CPT 92326
Global XXX ActiveReplacement of contact lens
This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.
CPT 92326 Billing & Documentation Guide
CPT code 92326 (Replacement of contact lens) is classified under Ophthalmology with a global period indicator of XXX. This code uses the No national RVU payment methodology rather than standard RVU-based Physician Fee Schedule pricing. Refer to the methodology notice above for billing implications.
When billing 92326, 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 92326 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 2 units of 92326 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
2026 Medicare Reimbursement by State, CPT 92326
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 | $46.03 | $46.03 | $42.64 - $56.05 | 29 |
| Florida | $39.52 | $39.52 | $37.54 - $41.18 | 3 |
| Georgia | $37.37 | $37.37 | $34.96 - $39.77 | 2 |
| Illinois | $38.08 | $38.08 | $35.9 - $40.38 | 4 |
| Michigan | $36.85 | $36.85 | $35.75 - $37.95 | 2 |
| North Carolina | $36.36 | $36.36 | $36.36 - $36.36 | 1 |
| New York | $43.68 | $43.68 | $37.04 - $46.69 | 5 |
| Ohio | $35.71 | $35.71 | $35.71 - $35.71 | 1 |
| Pennsylvania | $38.31 | $38.31 | $35.88 - $40.73 | 2 |
| Texas | $38.46 | $38.46 | $35.57 - $41.29 | 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 92326
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92326 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 |
| 92311 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 92312 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 92313 | 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 |
| 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 92326
What does CPT code 92326 mean? +
CPT code 92326 represents: Replacement of contact lens. It's in the Ophthalmology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92326? +
The 2026 Medicare national average non-facility payment for CPT 92326 is $40.72. Rates range from $33.45 to $56.05 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92326? +
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 92326? +
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 April 17, 2026.
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