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PAYER POLICY CHANGES

92310 Insurance Policy Changes

CPT 92310, in plain terms, covers Prescription and fitting of corneal contact lenses for both eyes, excluding aphakia. CPT 92310 is referenced in 4 tracked payer policy changes from Wisconsin Medicaid (ForwardHealth), Wisconsin ForwardHealth, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92310 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 92310 on AAPC

Watch 92310

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Louisiana Healthcare Connections CMS-0057-F prior authorization requirements

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 92310?

Ambetter lists 92310 on Ambetter from Louisiana Healthcare Connections CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 92310?

CalViva Health lists 92310 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for 92310?

Centene lists 92310 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 92310?

Community Health Plan of Imperial Valley lists 92310 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 92310?

There are 4 tracked policy changes affecting CPT 92310, including updates from Wisconsin Medicaid (ForwardHealth), Wisconsin ForwardHealth, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 92310?

Payers that have issued tracked updates for CPT 92310 include: Wisconsin Medicaid (ForwardHealth), Wisconsin ForwardHealth, Aetna.

How do I get notified when CPT 92310 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 92310. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 92310?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 92310

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 92310 in one place.

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RELATED

All billing codesJ3590C9399J3490992159921399202

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