Revenue Cycle Insider

Question: Which code should we use to report monthly toric contact lens replacements?

Oklahoma Subscriber

Answer: You’ll assign HCPCS Level II code V2521 (Contact lens, hydrophilic, toric, or prism ballast, per lens) to report monthly toric contact lenses, which are prescribed for astigmatic patients. The disposable lenses are most likely to be soft since they’re hydrophilic, making V2521 the appropriate contact lens code.

However, if the physician prescribed toric gas-permeable lenses, you’ll report V2511 (Contact lens, gas permeable, toric, prism ballast, per lens), but these lenses probably would not be a monthly contact replacement.

According to hydrophilic contact lenses national coverage determination (NCD), Medicare won’t cover these specific lenses “when [they are] used in the treatment of non-diseased eyes with spherical ametrophia, refractive astigmatism, and/or corneal astigmatism.”

Mike Shaughnessy, BA, CPC, Development Editor, AAPC