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PAYER POLICY CHANGES

92311 Insurance Policy Changes

CPT 92311, in plain terms, covers Fitting contact lenses for a patient whose eye lacks a natural lens, typically after cataract surgery. CPT 92311 is referenced in 1 tracked payer policy change from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92311 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 92311 on AAPC

Watch 92311

Get one email when a payer policy names 92311, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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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 92311?

Ambetter lists 92311 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 92311?

CalViva Health lists 92311 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 92311?

Centene lists 92311 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 92311?

Community Health Plan of Imperial Valley lists 92311 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 92311?

There are 1 tracked policy change affecting CPT 92311, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 92311?

Payers that have issued tracked updates for CPT 92311 include: Aetna.

How do I get notified when CPT 92311 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 92311. 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 92311?

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 92311

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 92311 in one place.

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