CPT code 92311: Contact lens fitting, aphakia, one eye2026 Medicare rate & RVUs in California
Reports the clinical fitting of a contact lens for one aphakic eye, including lens selection, fit assessment, and medical oversight during adaptation.
Medicare pays $105.40–$130.62 for 92311 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 92311 covers
92311 covers contact lens fitting for one aphakic eye, meaning the eye lacks its natural crystalline lens. A typical situation is aphakia after cataract removal when no intraocular lens was placed; congenital aphakia is another possible cause. An ophthalmologist or optometrist selects the lens characteristics, evaluates fit and visual effect, and oversees the patient’s adaptation. The service may include trial-lens assessment and instruction in lens handling, usually in an eye-care office.
Report 92311 for fitting one eye. When both aphakic eyes are fitted, 92312 is the bilateral sibling rather than two units of 92311. Documentation should identify the eye and support the aphakic diagnosis, fitting performed, and lens characteristics selected. Distinguish a fitting from a routine fitting for an eye without aphakia, a technician-performed fitting, or a later lens adjustment or replacement. CMS values the service using physician work, practice expense, and malpractice inputs; the practice-expense inputs differ between office and facility settings.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 92311 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$105.40 to $130.62
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $105.49 | $43.26 |
| Chico, CA | $105.40 | $43.17 |
| El Centro, CA | $105.40 | $43.17 |
| Fresno, CA | $105.40 | $43.17 |
| Hanford, CA | $105.40 | $43.17 |
| Los Angeles, CA | $111.81 | $44.63 |
| Madera, CA | $105.40 | $43.17 |
| Marin County, CA | $128.04 | $47.98 |
| Merced, CA | $105.40 | $43.17 |
| Modesto, CA | $105.40 | $43.17 |
| Napa, CA | $121.09 | $46.25 |
| Oxnard, CA | $111.27 | $44.16 |
| Redding, CA | $105.40 | $43.17 |
| Rest of California | $105.40 | $43.17 |
| Riverside, CA | $105.54 | $43.31 |
| Sacramento, CA | $110.32 | $44.28 |
| Salinas, CA | $109.89 | $44.08 |
| San Benito County, CA | $130.62 | $48.74 |
| San Diego, CA | $112.20 | $44.29 |
| San Francisco, CA | $128.03 | $47.96 |
| San Luis Obispo, CA | $108.13 | $43.45 |
| Santa Clara County, CA | $130.57 | $48.69 |
| Santa Cruz, CA | $113.09 | $44.10 |
| Santa Maria, CA | $110.23 | $44.02 |
| Santa Rosa, CA | $114.23 | $44.51 |
| Stockton, CA | $105.40 | $43.17 |
| Vallejo, CA | $121.08 | $46.24 |
| Visalia, CA | $105.40 | $43.17 |
| Yuba City, CA | $105.40 | $43.17 |
How the 92311 rate is calculated
Each of 92311’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 92311
RVUs × geographic indexes × conversion factor
Work1.05
1.05 RVUs× 1.000 GPCI
Practice expense1.90
1.90 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
2.9600
Conversion factor
$33.4009
Medicare rate
$98.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92311
92311 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 92311
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$98.87
- Non-facility (office)
- $98.87
- Facility
- $42.09
Higher because the practice carries its own overhead.
92311 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 92312Contact lens fittingAphakia, both eyes
- Choose 92312 when both aphakic eyes are fitted. 92311 describes fitting one aphakic eye.
- 92310Contact lens fittingBoth eyes; non-aphakic
- 92310 is for contact lens fitting in eyes without aphakia; 92311 is for one aphakic eye.
- 92315Contact lens fittingTechnician, one aphakic eye
- 92315 is the technician-performed fitting for one aphakic eye. 92311 describes the fitting service with medical oversight of adaptation.
- 92325Lens modificationPhysical lens alteration
- 92325 describes modification of an existing contact lens. 92311 is for fitting a lens for one aphakic eye.
92311 billing questions
When should 92311 be used instead of 92312?
Use 92311 when the fitting is for one aphakic eye. Use 92312 when both aphakic eyes are fitted; do not report two units of 92311 for that bilateral fitting.
How should the record identify the eye?
Document which eye is aphakic and being fitted, along with the fitting work and selected lens characteristics. The code represents one eye.
Is this the code for fitting a contact lens in a nonaphakic eye?
No. For a standard corneal contact lens fitting in an eye without aphakia, consider 92310; 92311 is specific to aphakia in one eye.
Does 92311 describe lens modification or replacement?
No. Code 92325 describes modification of an existing contact lens, while 92326 describes replacement; 92311 is for the aphakic fitting service.
How does 92311 differ from 92315?
Both concern fitting for aphakia in one eye. 92315 is the technician-performed fitting code; 92311 describes the fitting service with medical oversight of adaptation.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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