First and foremost, it is important for eyecare practitioners and staff to be on the same page in order to provide the highest level of patient care. Fees need to be discussed with the whole office! Eyecare professionals need to choose levels of codes all the time (92xxx and 99xxx codes, contact lens evaluation levels, etc.); consistency is key with how those fees are applied.

As it applies to contact lens fit levels, the level of codes chosen are based on many factors, including difficulty to fit and the time needed to fit those specific patients. These definitions have evolved over time, and medical and vision insurance carriers have added their interpretation of these levels. Most insurance carriers define the more standard or lower-level contact lens evaluation fee as a returning patient who wears spherical, single-vision contact lenses. The more advanced or premium evaluation fees are often the more complex lenses wearers, such as overnight, toric, and multifocal wearers.

With those definitions, it is important to apply the coding guidelines uniformly. Even if there is no change in the prescription, some lenses take more time and expertise. Eyecare professionals need to measure the toric markings and potentially make an axis shift in the prescription. It is important to understand the design of the multifocal lens and the fitting guide in order to maximize success with those lenses. If patients wear their contact lenses overnight, they are at more risk of a corneal ulcer, and it takes more time to discuss their wearing habits with them. Those challenges often lead to a higher level of code chosen.

Each office can mitigate any fee questions by having a strong handoff: “Hi [staff member], Mrs. Smith is doing great with her multifocal contact lenses. I have finalized her contact lens prescription and authorized to order her annual supply of contact lenses. I’ve explained her contact lens evaluation may be covered partially by her insurance.” Develop your infrastructure for contact lens fees in order to maximize success with daily disposable contact lenses.

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