Summary & Overview
CPT 92311: Contact Lens Fitting and Prescription for One Aphakic Eye
CPT code 92311 covers the prescription and fitting of a contact lens for a single aphakic eye after cataract extraction. This procedure is clinically important for restoring visual function in patients who no longer have the natural lens and for whom an intraocular lens may not be used or is contraindicated. Nationally, services addressing post-cataract aphakia remain a focused component of ophthalmic rehabilitative care and carry implications for outpatient eye care utilization and coverage policy.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for CPT code 92311, national coverage considerations, and the typical sites of service where this fitting occurs. The publication outlines benchmark coding practices, common billing modifiers and coding considerations (listed elsewhere in the report), and clarifies where input data are complete or absent.
The content provides clinicians, billing professionals, and policy analysts with operational clarity about when CPT code 92311 applies, the clinical scenario it represents, and what to expect in terms of payer engagement and typical outpatient delivery settings. Data not available in the input are clearly noted in the detailed sections.
Billing Code Overview
CPT code 92311 describes the provision, prescription, and fitting of a contact lens for one eye that is aphakic following cataract surgery. This service involves selecting and fitting a contact lens for a single eye rendered without the natural lens, typically to correct vision after lens extraction.
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Service type: Contact lens fitting and prescription for a single aphakic eye
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Typical site of service: Eye care clinics, ophthalmology or optometry offices, and outpatient specialty clinics
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who previously underwent cataract extraction without intraocular lens implantation or whose intraocular lens was removed, resulting in an aphakic eye requiring optical correction. The patient presents to a specialty ophthalmology or optometry clinic for evaluation: history and review of previous surgical records, manifest refraction, slit-lamp exam, corneal topography if irregular astigmatism is suspected, and assessment of ocular surface health. The provider then determines that a contact lens is the appropriate aphakic correction for one eye and performs trial lens fitting, evaluates fit and centration, measures vision with the trial lens, instructs the patient on insertion, removal, and contact lens care, and documents the prescription and lens parameters. Typical site of service is an outpatient ophthalmology or optometry clinic; the service is billed when the provider prescribes and fits a contact lens for one aphakic eye, coded as 92311.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician's professional service separate from technical components (rare for contact lens fitting). |
51 |