Ophthalmology and Optometry Coding Alert

Question: We know we can’t bill Medicare for regular refractive contact lenses, but how can we collect for contact lens services if the patient has keratoconus?

Texas Subscriber

Answer: You are correct when you say that you can’t simply report 92310 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia) if the patient has keratoconus, because this code applies to corneal lenses, and your situation is different.

Solution: To avoid denials when the eye care physician prescribes a contact lens to treat keratoconus, use 92072 (Fitting of contact lens for management of keratoconus, initial fitting). For mild cases of keratoconus, glasses may adequately correct the patient’s vision. More severe cases of keratoconus may require hard or gas-permeable contact lenses.

Based on the 2022 Medicare physician fee schedule, unadjusted for geographic location, you can expect about $129.08 when you report 92072.