Contact lenses are a ubiquitous part of eyecare practice. Over the past decade, we have witnessed continuous erosion of revenues related to materials. As competitive sales channels abound, the average practitioner has had to take advantage of more sophisticated sales strategies, such as annual supply, direct ship, and, of course, unilateral pricing policies (UPPs), though they failed to prop up prices to the consumer. With the exception of UPPs, the success of these strategies relies on the communication skills of your team.

Contact Lens Services

The obvious oversight here is that we are trying to compete with market variables that we can’t control rather than concentrating on what we can: the contact lens prescription. The prescription is not simply the type of lens and the refraction, as some treat it, but is the result of a much more complicated process: a contact lens fitting as defined by the CPT. In fact, the CPT is fairly comprehensive regarding what is included in a contact lens fitting:

  • The prescription of contact lens includes specification of optical and physical characteristics (power, size, curvature, flexibility, gas permeability). It is not a part of the general ophthalmological services.
  • The fitting of a contact lens includes instruction and training of the wearer and incidental revision of the lens during the training period. Supply of materials may be reported as part of the fitting service or may be reported separately using the appropriate supply codes.
  • Follow up of successfully fitted extended wear lenses is reported as part of a general ophthalmological service (92012).

A deeper dive into the 2017 definition of the most common contact lens fitting code, 92310, shows that we have significant responsibility when it comes to fitting a lens:

  • 92310—“prescription of optical and physical characteristics of and fitting of a contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia.” If fitting only one eye, use modifier -52, not the -RT or -LT modifier (implemented in 2011).

A 92310 code encompasses fitting services up to the point at which you would issue a contact lens prescription. Some important additional points to understand:

  • This code does not include contact lens follow-up care after the lenses have been dispensed.
  • This code is charged at every visit that a new lens is placed on a patient’s eye or the fit is altered. Incidental revisions without altering the fit, such as power changes, are not billed as a new fitting.

Practitioners are giving away thousands of dollars in revenue by including these services as “free care” for patients. If you are refitting a patient and not performing an “incidental revision of the contact lens,” then you should bill the patient again for your expertise in correcting the clinical issue at hand.

Code Appropriately

The price battle will continue for the materials in a market led by retail powers that are far more sophisticated and have greater profit elasticity than what the average practitioner can sustain. However, retailers have nothing to sell if a prescription is not issued. Those who control the fit control the prescription and, thereby, have better control over profitability related to their intellectual property. A more in-depth understanding of what you are truly providing as defined by the CPT may help you understand the true value of the lens fit and its role in your practice profitability. CLS

This article also appears in Optometric Management, May 2017.