Summary & Overview
CPT 92310: Comprehensive Contact Lens Evaluation and Fitting
CPT code 92310 designates a comprehensive contact lens prescription and fitting service for both eyes, excluding cases of aphakia from prior cataract surgery. This procedure is a distinct eye care service that establishes lens parameters, fit, and prescription for contact lens wearers, and it is commonly billed in outpatient ophthalmology and optometry settings. Nationally, accurate use of this code affects coverage determinations, patient access to corrective devices, and provider reimbursement for vision services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for contact lens fitting, common payer coverage considerations, typical sites of service, and benchmarking perspectives where available. The publication outlines how CPT code 92310 is used in practice, highlights common billing and coding themes, and summarizes informational policy updates relevant to contact lens prescription and fitting. This resource serves clinical, billing, and policy audiences seeking a national-level understanding of the code's purpose, typical service delivery settings, and payer landscape.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, specific modifiers usage rates, and payer-specific reimbursement figures; those details are omitted where not provided.
Billing Code Overview
CPT code 92310 describes a comprehensive contact lens evaluation and fitting performed by a qualified provider for both eyes. The service includes all components of contact lens prescription and fitting when the patient is not aphakic due to prior cataract surgery.
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Service type: Comprehensive contact lens evaluation and fitting
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Typical site of service: Outpatient eye care settings such as ophthalmology or optometry clinics and ambulatory surgical or specialty eye care centers
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Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to an ophthalmology clinic with progressive contact lens intolerance and fluctuating vision despite over-the-counter lenses. The provider performs a comprehensive contact lens evaluation and fitting for both eyes, including case history, refraction, corneal curvature measurement (keratometry/topography), slit-lamp anterior segment exam, trial lens fitting, assessment of fit and visual acuity with the trial lens, and final contact lens prescription. The clinical workflow begins with intake and history, followed by objective and subjective refraction, corneal assessment to determine lens parameters, selection and application of diagnostic lenses, evaluation of lens centration and movement, patient instruction on insertion/removal and care, and documentation of the final prescription and patient tolerance. The service excludes fitting for aphakia following prior cataract surgery; those cases require alternate codes. Typical equipment used includes a phoropter or autorefractor, keratometer/topographer, slit-lamp biomicroscope, and trial lens set. Typical visit duration ranges from 30 to 60 minutes depending on complexity and patient adaptation needs. Typical sites of service are ophthalmology or optometry outpatient clinics and specialty contact lens fitting centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient visit, typically 99211-99215 primary care; used as a place-of-service indicator | When reporting an E/M service performed in conjunction and separately identifiable from the fitting, if applicable |