Wiki Glasses billing help

[schaunarae]

I have a payer (BCBS MN) Medicare Advantage plan who just will not pay us for glasses after cataract surgery..

The XZL prefix mostly come back as CO-109's.

Example of what we bill out with POS 12:

V2020 Z96.1
V2303 Z96.1 RT
V2303 Z96.1 LT

Any thoughts?

 

[thomas7331]

I have a payer (BCBS MN) Medicare Advantage plan who just will not pay us for glasses after cataract surgery..

The XZL prefix mostly come back as CO-109's.

Example of what we bill out with POS 12:

V2020 Z96.1
V2303 Z96.1 RT
V2303 Z96.1 LT

Any thoughts?

A CO-109 denial suggests that you may have submitted the claim to the wrong place. Have you checked to see if this patient's plan uses an outside contractor to process their vision and/or DME benefits, or requires vision claims to be submitted using a different member ID number?

 

[Cheezum51]

Mlst of the MA plans have contracted the eyeglass payments to various vision plans. Eyemed seems to be the most dominant. If you aren't a provider for the vision plan, then they most likely won't pay you.

Also, for your diagnosis codes, you may want to use the z98.41 and Z98.42 instead of the z96.1.

Tom Cheezum, OD, CPC, COPC

 

[CBP2014]

File post cataract glasses with Z98.41 or Z98.42 rather than Z96.1
When we file to Medicare DME contractor, we have to use place of service 12 (home) rather than 11 (office).