Ophthalmology and Optometry Coding Alert

Question: Is there a supply code for a bandage contact lens that I can bill to Medicare? Do we need to register with Medicare as a supplier to bill? How does this work?

Massachusetts Subscriber

Answer: The supply code for a bandage contact lens is code 99070 (Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)).

However, CMS lists 99070 as a “B” bundled code with 0 relative value units in the Physician Fee Schedule. “B” status indicates that 99070 is a bundled code. In other words, Medicare bundles payment for this code into payment for other services not specified.

Rationale: The American Medical Association (AMA) and Medicare already factor essential medical supplies into a code’s values on the provider fee schedule. If you’re doing a procedure in the office that requires tools, surgical trays, or other supplies, the reasonable expectation is that you will be using equipment and the pricing for the procedure accounts for those costs. The purpose of the site of service differential in the Medicare fee schedule is to include these supplies and services. That’s why you get paid more for the same procedure done in the office versus a facility.

You can use 99070 for separately billable supplies in your office. You could use HCPCS code V2599 (Contact lens, other type), but bear in mind there’s no specific HCPCS code for a bandage contact lens. If you use 99070, you will need to provide a description of the supply and possibly a copy of the invoice from your supplier for pricing.