Optometry Coding & Billing Alert

Published on Fri Jan 07, 2005 PDF

Question: When billing 92312 for a Medicare patient with aphakia, should I also bill the V code or does CPT code 92312 include the materials' cost?


New York Subscriber


Answer: Unlike 92070 (Fitting of contact lens for treatment of disease, including supply of lens), CPT code 92312 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens for aphakia, both eyes) does not include supply of the lens. However, you should not bill Medicare for the supplies.

Bill your DMERC for the lenses themselves using the HCPCS V25xx codes (for example, V2510, Contact lens, gas permeable, spherical, per lens; or V2522, Contact lens, hydrophilic, bifocal, per lens), adding the -RT and -LT modifiers for each eye and modifier -KX (Specific required documentation on file) to indicate medical necessity.