You’ve fit a patient with great new lenses for keratoconus, but now how do you get paid? This is a common, frustrating topic for many practitioners. We would all love to give our services away for free, but someone needs to pay the electric bill to keep the lights on! In this article, I will break down the basics of billing and coding for specialty lens patients. Keep in mind, different insurance companies have different rules and recommendations for which codes to use, but here I will outline some of the basics to get you started.
Codes for Contact Lens Fitting
92310 Contact lens fitting for corneal lenses, both eyes, except for aphakia. Use this code when fitting soft contact lenses or corneal GP lenses, unless a patient has aphakia. This is a bilateral code, so you would only bill this code once, even if you fit both eyes.
92311 Contact lens fitting of a corneal lens for aphakia, one eye. Use this code when you are fitting a soft or corneal GP lens for aphakia on only one eye.
92312 Contact lens fitting of a corneal lens for aphakia, both eyes. Use this code if you are fitting a soft or corneal GP lens for aphakia if you are fitting both eyes.
92313 Contact lens fitting of a corneoscleral lens, both eyes. Use this code if you are fitting corneoscleral, mini scleral, or full scleral lenses.
92071 Fitting of a contact lens for treatment of ocular surface disease. A common use of this code would be for punctate keratitis due to dry eye, in which practitioners utilize a bandage contact lens. This code is only for the contact lens fitting portion, so be sure to bill for the supply of the lens separately.
92072 Fitting of a contact lens for management of keratoconus, initial fitting. Use this code when you are fitting a patient who has keratoconus, no matter what type of lens you select.
This code can be a bit ambiguous. What does “initial fitting” mean? Do you use this code only when you first fit patients? What code do you use if you need to refit them next year? What if they are new to you but were previously fit by another practitioner—was that their “initial fitting”? I do not have the answers to these questions, as insurance companies have all told me different definitions and rules. However, Dr. John Rumpakis and Dr. Clarke Newman are billing and coding experts; they have written some terrific articles on specialty lens billing.
92499 Other ophthalmological services or procedures. I use this code when I am fitting custom sclerals from an impression.
Codes for Lens Materials
V2510 Contact lens, GP, spherical, per lens.
V2511 Contact lens, GP, toric, per lens.
V2512 Contact lens, GP, bifocal, per lens. Examples would be a translating multifocal GP lens or an aspheric multifocal GP lens.
V2513 Contact lens, GP, extended wear, per lens. Use this code for hyper-Dk GP lens materials or when prescribing overnight wear.
V2520 Contact lens, hydrophilic, spherical, per lens. Use for any spherical soft contact lens.
V2521 Contact lens, hydrophilic, toric, per lens. Use for any standard soft toric lens.
V2522 Contact lens, hydrophilic, bifocal, per lens. Use for any standard soft multifocal lens.
V2523 Contact lens, hydrophilic, extended wear, per lens. Use this code for high-Dk soft lenses or when prescribing overnight wear.
V2531 Contact lens, GP, scleral, per lens. Use this code when fitting scleral lenses (including corneoscleral, mini scleral, or full scleral). Do not use V2530, which is for a scleral lens that is gas impermeable. Most modern scleral lenses are made of GP materials, except for extremely rare cases of PMMA scleral lenses for patients who have phthisical eyes.
V2599 Other type of contact lens. Use this code for lenses such as hybrids or custom sclerals from an impression.
V2627 Scleral cover shell.
You can also find these codes on the GP Lens Institute website at www.gpli.info . CLS