92312 Contact lens fitg aphakia ou
What 92312 is
CMS fee schedule short descriptor: Contact lens fitg aphakia ou.
Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.
Medicare payment for 92312 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 1.23 | 2.15 | 0.01 | 3.39 | $113.23 |
| Facility (hospital, ASC) | 1.23 | 0.23 | 0.01 | 1.47 | $49.10 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.
Medically Unlikely Edit (MUE)
Medicare caps 92312 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 92312? These codes are bundled into it
92312 is a Column 1 code in 5 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
92325 | Modification of contact lens | 0 - no modifier bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
99211 | Off/op est may x req phy/qhp | 1 - modifier may bypass | Check pair |
92312 is bundled into these codes
92312 appears as a Column 2 code in 2 active edits. Reported with one of these Column 1 codes on the same date of service, 92312 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
92311 | Contact lens fitg aphakia 1 | 1 | Check pair |
92326 | Replacement of contact lens | 1 | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.