Monthly Newsletter
May 2024
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SPOTLIGHT ON EDUCATION Part 1: Specialty Contact Lens Coding and Billing Update

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
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