Billing Medically Necessary Contact Lenses
8:40 PMSo in my first year of practicing, insurance billing has been the biggest learning curve I have faced. They try to prepare you in school. They try to prepare you at your externships. But the problem is that billing and coding seem to be changing every couple months. Here is a review of the latest coding conundrum I have faced:
Insurances for Medically Necessary Contact Lenses
First off, not all insurances are going to offer any coverage for contact lenses. With time and experience, you will learn which insurances reimburse anything. So far I have successfully filed to VSP, Eyemed, and Superior Vision for visual conditions that require contact lens correction. Medical insurances like Blue Cross are not going to cover anything for vision correction. Medicaid (at least in NC) will offer some base level of reimbursement if filed correctly. On the contrary, if you have a corneal abrasion or another condition where a bandage contact lens is appropriate, medical insurances like Blue Cross WILL offer coverage and vision insurances will not.
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| Medically necessary contact lenses for post-RK |
Not all vision insurances cover medical contact lenses for vision correction to the same amount of reimbursement. Some insurances will reimburse cost of lenses and evaluation fee. Some will only give a certain amount of dollars to be applied toward eval or lenses. Just remember, if you are going to try to bill for contact lenses, do NOT use the patient's insurance benefits towards glasses. Once the insurance has been used, they won't provide for anything else.
What Conditions Typically are Covered
Again, different insurances have different guidelines, but here are the most commonly accepted reasons for medically necessary lenses:
- Keratoconus, pellucid marginal degeneration, or a corneal degenerative condition where vision improves in contact lenses versus glasses
- High anisometropia (usually there are guidelines about how much, typically between 3D and 5D minimum)
- Condition where best corrected vision improves by at least 2 lines with use of contact lenses versus glasses (this includes high refractive error conditions)
- Bandage contact lenses for treatment of ocular surface conditions (this is typically with a medical office visit code and is billable to medical insurances, unlike the previous items)
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| Synergeyes ClearKone lens is a great option for medically necessary keratoconus correction |
- 92071 Fitting of contact lens for treatment of ocular surface disease (this is your bandage lens code)
- 92072 Fitting of contact lens for management of keratoconus
- 99070 Supply of materials (I have never tried billing this, but apparently you can bill this with a bandage lens code)
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3 comments
VSP will cover lenses for glasses if needed over visually necessary contact lenses. For example, I wear Kerasoft IC for keratoconus and I also get glasses because of presbyopia. In my case it is a toss-up over just paying OOP for over the counter readers.
ReplyDeleteI am experiencing frustration and difficulty with WEA Insurance in the State of Wisconsin with their continued refusal to provide coverage for a bandage contact lens for an eye injury I sustained months ago that has now been identified as a case of recurrent corneal erosion. The code displayed on my billing paperwork is 92071-RT. I have discovered that even Medicare provides coverage for this code.
ReplyDeleteDo you have any suggestions or comments on how to proceed with this frustrating situation?
In advance, thank you for your time.
Todd
Unfortunately everyone's insurance is so different. The best thing to do is to call the insurance directly and ask them about coverage of this code. They can explain to you in detail why the claim was denied or if it was denied in error, they can refile for you.
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