Billing code 92316: Contact lens fittingMedicare rate & RVUs in Illinois
Reports technician-performed contact lens fitting for aphakia in both eyes, including assessment and selection of lenses to address the absence of natural lenses.
Medicare pays $91.49–$100.31 for 92316 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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.
On this page 9 sections
What 92316 covers
This service covers fitting contact lenses for a patient with aphakia, meaning the natural crystalline lens is absent, in both eyes. A technician performs the fitting, which may involve assessing lens fit and visual performance and selecting lenses appropriate for the patient’s needs. It is distinct from fitting contact lenses for a patient without aphakia and from fitting a lens for only one aphakic eye.
Report the code when the technician provides the fitting service for both eyes, rather than for dispensing an already-fitted lens alone. The record should support aphakia in both eyes and document the fitting work performed. CMS prices this code as bilateral: report the service for both eyes under this code, and modifier 50 does not increase payment.
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 92316 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
$91.49 to $100.31
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $98.83 | $26.99 |
| East St. Louis | $92.16 | $26.40 |
| Rest Of Illinois | $91.49 | $26.23 |
| Suburban Chicago | $100.31 | $26.91 |
How the 92316 rate is calculated
Each of 92316’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 · 92316
RVUs × geographic indexes × conversion factor
Work0.66
0.66 RVUs× 1.000 GPCI
Practice expense2.26
2.26 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
2.9300
Conversion factor
$33.4009
Medicare rate
$97.86
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92316
The CMS indicators that decide how 92316 is paid alongside other services.
CMS payment indicators · 92316
Contact lens fitting
| 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) | 2 | Already bilateral by definition: paid once at 100%. |
| 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 | 0 | Physician service: no professional/technical split. |
92316 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92312Contact lens fitting
- Both codes concern fitting contact lenses for aphakia in both eyes. Choose 92316 when the technician designation applies; 92312 is the corresponding code without that designation.
- 92315Contact lens fitting
- Both identify technician-performed contact lens fitting for aphakia. Code 92315 is for one eye; 92316 is for both eyes.
- 92314C-lens fitg tech ou
- Both describe technician-performed fitting for both eyes, but 92316 is for aphakia and 92314 is for fitting without aphakia.
92316 billing questions
When should this code be used instead of 92314?
Use 92316 for a technician-performed fitting in a patient with aphakia in both eyes. Code 92314 is for a technician-performed fitting in a patient who does not have aphakia.
Should modifier 50 be appended?
The code is already priced as bilateral, and modifier 50 does not increase payment. It represents fitting for both eyes.
How does this differ from 92312?
Both codes describe contact lens fitting for aphakia in both eyes. Code 92316 identifies the technician-performed service; 92312 is the corresponding fitting code without the technician designation.
What documentation supports reporting this code?
Document aphakia in both eyes and the technician’s fitting work, such as assessment of lens fit or visual performance and lens selection.
Can this code be used for one aphakic eye?
No. This code is for fitting in both eyes. Code 92315 is the technician fitting code for aphakia in one eye.
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
Show the CMS file lines behind this rate
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