CPT code 92326: Lens replacement, existing contact lens2026 Medicare rate & RVUs in Illinois
Report this service when a replacement contact lens is provided for an existing wearer, rather than when a new lens fitting or lens modification is performed.
Medicare pays $35.90–$40.38 for 92326 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. 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 92326 covers
This service covers replacing a contact lens for someone who already wears contact lenses. An ophthalmologist or optometrist may provide or oversee the service in an eye-care office; a replacement may be needed when a lens is lost, damaged, or no longer usable. The replacement itself is distinct from evaluating and fitting a new lens or altering an existing lens.
Report one unit for each lens replaced, and document the eye, the replacement provided, and why it was needed. Do not treat dispensing a replacement as proof that a separate fitting or modification was performed. Under the CMS incident-to rule, office staff may perform the service for billing only when it is performed under physician supervision.
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 92326 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$35.90 to $40.38
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $39.71 | Unavailable |
| East St. Louis, IL | $36.32 | Unavailable |
| Rest of Illinois | $35.90 | Unavailable |
| Suburban Chicago, IL | $40.38 | Unavailable |
How the 92326 rate is calculated
Each of 92326’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 · 92326
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense1.16
1.16 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
1.1700
Conversion factor
$33.4009
Medicare rate
$39.08
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92326
The CMS indicators that decide how 92326 is paid alongside other services.
CMS payment indicators · 92326
Lens replacement, existing contact lens
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
92326 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92325Lens modificationPhysical lens alteration
- Use 92326 when a lens is replaced. Use 92325 when an existing contact lens is modified instead.
- 92310Contact lens fittingBoth eyes; non-aphakic
- 92310 describes a contact lens fitting; 92326 describes replacement of a lens for an existing wearer.
- 92314Contact lens fittingTechnician, both eyes
- 92314 identifies a technician-performed fitting service. It is not the code for providing a replacement lens.
92326 billing questions
When should I use 92326 instead of a contact lens fitting code?
Use 92326 for replacing a lens for an existing wearer. A fitting code describes a fitting service, not simply the provision of a replacement lens.
How many units should I report?
Report one unit for each lens replaced. Document which eye received the replacement.
Can office staff perform this service?
Yes, but CMS permits billing as an incident-to service only when it is performed under physician supervision.
Does a replacement include a fitting or lens modification?
The replacement service does not by itself establish that a fitting or modification occurred. Report those services only when they were separately performed and documented.
What documentation supports 92326?
Record the existing contact lens use, the eye and lens replaced, and the reason a replacement was needed.
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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