CPT code 92310: Prescription of optical and physical characteristics of and fitting of contact lenses

Know more about the documentation requirements and billing guidelines of CPT code 92310 to more accurately use and bill this code.

Use Code

What is the 92310 CPT code?

CPT code 92310 is described as "Prescription of optical and physical characteristics of a fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia."

To elaborate, it describes the fitting of medically necessary contact lenses for a patient, which includes the following:

Initial assessment and evaluation of the eye health and vision needs
Measurement of corneal curvature
Determination of appropriate lens parameters
Selection and trial of contact lenses
Initial contact lens fitting and evaluation
Patient education
Medical supervision ofthe adaptation process
Follow-up visits for assessing fit, monitoring adaptation, etc.

Do note that this code is different than that of the one for a routine eye examination.

CPT code 92310 documentation requirements

Documentation must include:

Patient history and symptoms
Reason for contact lens fitting (e.g., myopia, hyperopia, astigmatism)
Ocular measurements
Type of lenses selected (soft contact lenses, rigid gas-permeable, etc.)
Measurements and parameters (base curve, power, diameter)
Rationale and clinical decision
Initial fitting of the lens, its placement, and evaluation
Patient education

Any medical necessity (if applicable) for specialty contact lenses must be clearly differentiated to avoid confusion with therapeutic lens codes.

CPT code 92310 billing guidelines

To ensure accurate reimbursement for the contact lens services offered, the following billing guidelines must be followed:

Bill separately from the comprehensive eye exam (e.g., 92004) and refraction (92015).
Append the needed modifiers, especially if the fitting is only performed for one eye
Most vision plans may cover only a portion or limit the frequency of this service. With regards to Medicare, it typically does not reimburse for the code.
Does not include supply of lenses or the lens materials—billed separately if dispensed in office.