Ophthalmology and Optometry Coding Alert

Question: One of our patients has a plan that covers progressive bifocal lenses. I see the HCPCS Level II code set has codes for progressive lenses and codes for bifocal lenses, but no codes for progressive bifocals. How should we report these lenses?

Kansas Subscriber

Answer: Progressive bifocal lenses should be reported with codes on two lines, according to the Centers for Medicare & Medicaid Services (CMS). You’ll assign the appropriate bifocal lens code from the V2200-V2299 bifocal range or the appropriate trifocal lens code from the V2300-V2399 trifocal range on the first line.

“When billing claims for progressive lenses, use the appropriate code for the standard bifocal … or trifocal … lenses and a second line item using code V2781 (Progressive lens, per lens) for the difference between the charge for the progressive lens and the standard lens,” writes CMS in Policy Article A54299, which was last updated in May 2022.

For your situation, you’ll assign the following codes:

• Line 1: Bifocal lens code from V2200 series
• Line 2: V2781

However, if the patient’s plan is with a private payer, you should confer with the payer on its preferred billing methods. While many commercial payers follow CMS rules, some insurance plans have their own way of coding that can vary greatly from Medicare.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC