CPT code 92313: Contact lens fitting, corneoscleral lens2026 Medicare rate & RVUs in Maryland
Clinician-directed corneoscleral lens fitting with supervised adaptation, commonly used when corneal shape or the ocular surface makes a standard corneal lens unsuitable.
Medicare pays $96.58–$108.78 for 92313 in the office in Maryland, from Rest of Maryland to Washington, DC area. 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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On this page 9 sections
What 92313 covers
Code 92313 describes a clinician-directed fitting of a corneoscleral contact lens, which vaults the cornea and bears on the sclera. An ophthalmologist or optometrist typically evaluates the eye, selects and assesses trial lenses, and supervises adaptation. This approach is often considered for irregular corneas, such as with keratoconus or after corneal transplantation, and for some ocular-surface conditions. Fitting may include evaluating lens position and clearance, vision, comfort, and the patient’s ability to handle the lens.
Choose this code for the corneoscleral lens service, rather than a standard corneal lens fitting or a technician-performed fitting. Documentation should support the lens type, clinical fitting work, assessment of the trial lens, and the clinician’s supervision of adaptation. The contact lens product is distinct from the fitting service and should be handled separately when reportable. CMS valuation uses work and practice-expense inputs, with practice expense valued differently for 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 92313 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$96.58 to $108.78
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $100.84 | $36.69 |
| Rest of Maryland | $96.58 | $36.08 |
| Washington, DC area | $108.78 | $38.35 |
How the 92313 rate is calculated
Each of 92313’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 · 92313
RVUs × geographic indexes × conversion factor
Work0.90
0.90 RVUs× 1.000 GPCI
Practice expense1.95
1.95 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
2.8600
Conversion factor
$33.4009
Medicare rate
$95.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92313
92313 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 · 92313
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$95.53
- Non-facility (office)
- $95.53
- Facility
- $35.74
Higher because the practice carries its own overhead.
92313 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92310Contact lens fittingBoth eyes; non-aphakic
- Use 92313 for a corneoscleral lens. Use 92310 for the specified standard corneal lens fitting.
- 92317Contact lens fittingTechnician, corneoscleral lens
- Both concern corneoscleral lenses, but 92317 is the technician-performed fitting code; 92313 describes clinician-directed fitting with medical supervision.
- 92311Contact lens fittingAphakia, one eye
- 92311 is for a corneal lens fitting in aphakia in one eye. 92313 identifies a corneoscleral lens fitting.
92313 billing questions
How is 92313 different from 92310?
92313 is for a corneoscleral lens fitting. 92310 is used for the specified standard corneal lens fitting, not the corneoscleral lens service.
Can a technician-performed corneoscleral fitting be reported with 92313?
92313 describes clinician-directed fitting with medical supervision of adaptation. Code 92317 is the technician fitting counterpart; select the code that matches who performed the service.
Does 92313 include the contact lens itself?
The code describes the fitting and supervised adaptation service, not the lens product. Handle the lens separately when it is independently reportable.
What documentation supports 92313?
Record why a corneoscleral lens was selected, the trial-lens assessment and fitting work, and the clinician’s role in supervising adaptation.
Does the code identify one eye or both eyes?
The code identifies a corneoscleral lens fitting and does not specify an eye in its descriptor. Follow current CPT reporting instructions for units and document the service performed.
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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