Does 92310 require prior authorization?

No, 92310 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92310?

Medicare facility rate: $48.77. Non-facility rate: $100.87. Work RVU: 1.14.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.14

Facility

$48.77

Non-Facility

$100.87

Providers must maintain a copy of the material invoice and a detailed description of the item(s) for all codes that are manually priced per the fee schedule.
Adhere to payer-specific administrative agreements and applicable federal/state (CMS or State Medicaid) guidelines; consult plan specifics and the applicable State Medicaid manual for payable services.
Providers must reference the most up-to-date CPT coding guidance and current professional coding sources prior to claims submission.
Documentation that the patient has received refractive hardware must be maintained.

Bandage contact lenses for noninfectious keratitis or corneal ulceration
Bandage contact lenses for recurrent corneal erosion
Bandage contact lenses for corneal abrasion, injury, burn, or other trauma
Bandage contact lenses for corneal perforation
Bandage contact lenses following corneal transplantation
Bandage contact lenses for dry eye refractory to more conservative treatments, including frequent artificial tears

AMBETTER-CP.VP.06 — Medically Necessary Optical Hardware

AMBETTER-CP.VP.13-Attachment-A-Refractive-Hardware — Preventive (Routine) Eye Examination Attachment A: Refractive Hardware

Ask Verity about documentation requirements, denial risks, or coverage in your state.