GPLI CONTACTS

Presented by Dr. Clarke Newman in May 2024

The topics presented included the following:

1. Course Objective: Discuss methods for coding and billing for medically necessary contact lenses and for incorporating ICD-10-CM into medically necessary contact lens prescribing.
2. Basic third party concepts
3. Covered versus non-covered services
4. CMS definition of medically necessary
5. Documentation on medically necessary
6. Guidance resource materials; important and review annually
7. Understanding CPT codes
8. Evaluation and management services – New Patient
9. What codes are affected
10. Other important procedure codes: includes myopia management
11. Important CPT Code Modifiers
12. Advanced Beneficiary Notification (ABN) Modifiers
13. Codes & Important Concepts for Contact Lens Services
14. Contact lens services – Keratoconus
15. HCPCS Material Codes
16. Using the unlisted codes
17. Documentation and other patient management issues
18. Clinical Example:
    1. Keratoconus unstable right eye: billing for the initial visit; billing for Eyemed
19. Vision Care Plans:
    1. Vision Service Plan® (VSP)
       1. Visually necessary contact lenses
       2. Qualified Diagnoses
       3. Exclusions
    2.  Eyemed®
       1. Eyemed® medically necessary contact lens benefit
       2. Operational Update: initiated May 1
    3. United Healthcare®/Spectera®
       1. Necessary contact lens benefit policy
       2. 92071 & 92072
       3. Limited data set
       4. Necessary contact lens modifiers
    4. Versant Health™ (Superior Vision™ & Davis Vision™)
       1. Non Elective medically necessary contact lens benefit
    5. Vision Benefits of America (VBA)
20. Other Billing Considerations
21. Final Thoughts