Optometry Coding & Billing Alert

Published on Mon Oct 27, 2008 PDF

There are a few HCPCS codes that your DME MAC will never cover. Make sure that the Medicare beneficiary knows he is fully responsible for payment for noncovered items. Have him sign an advance beneficiary notice (ABN) and keep it on file. Append modifier GA (Waiver of liability statement on file) to these HCPCS codes.

Although individual rules may vary, do not expect coverage from your DME MAC for the following:

• V2025 -- Deluxe frame

• V2702 -- Deluxe lens feature

• V2756 -- Eye glass case

• V2760 -- Scratch resistant coating, per lens

• V2761 -- Mirror coating, any type, solid, gradient or equal, any lens material, per lens

• V2762 -- Polarization, any lens material, per lens

• V2781 -- Progressive lens, per lens

• V2782 -- Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens

• V2783 -- Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens.

Tip: You don't need to append modifier EY (No physician or other licensed healthcare provider order for this item or service) to these HCPCS codes. If an item is never approved, like V2025, then GA is the only modifier used.