Summary & Overview
CPT 92316: Corneal Contact Lens Prescription and Supervised Fitting for Aphakia, Bilateral
CPT code 92316 covers provider-prescribed corneal contact lenses for both eyes in patients with aphakia, with the provider supervising the fitting performed by an independent technician. This code captures a specialized ophthalmic service addressing lens rehabilitation after loss of the natural lens, and it is relevant for practices that deliver prosthetic or optical correction for bilateral aphakia.
Key payers considered in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of clinical context for aphakic lens prescription, typical sites of service, and payer coverage considerations. The publication outlines common billing modifiers and operational touchpoints associated with supervised technician fitting (listed separately), and it summarizes how CPT code 92316 is used in claims for bilateral corneal contact lens services.
This summary is intended to inform billing managers, practice administrators, and clinical leaders about the role of CPT code 92316 in ophthalmic service lines, common payer stakeholders nationally, and the practical clinical scenario that the code represents. Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, and service-line metrics.
Billing Code Overview
CPT code 92316 describes the provider-prescribed fitting and dispensing of corneal contact lenses for both eyes in a patient with aphakia, where the provider directly supervises an independent technician who performs the fitting.
Service type: Contact lens prescription and supervised fitting for aphakia
Typical site of service: Ophthalmology clinic or specialty eye care practice, where a licensed eye care provider oversees lens selection and fitting and a trained technician executes the hands-on fitting process.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with bilateral aphakia following complicated cataract extraction presents for visual rehabilitation. The ophthalmologist evaluates the eyes, determines that corneal contact lenses are appropriate to restore refractive function, prescribes bilateral corneal contact lenses, and arranges for an independent technician to perform the fitting under the provider's supervision. The clinical workflow includes: initial provider evaluation and ocular surface assessment, lens prescription and documentation in the medical record, supervision of the technician during lens measurements and trial fitting, verification of fit and vision by the provider, and follow-up visits for lens adjustment and ocular health monitoring. Typical site of service is an ophthalmology clinic or ambulatory surgical center vision clinic where contact lens fitting equipment and diagnostic instruments are available.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician's professional portion of a service when a separate technical component exists. |
51 | Multiple procedures | Use when multiple procedures are billed on the same day and payer requires identification of multiple-procedure billing. |