Ophthalmology and Optometry Coding Alert

Answer: Medicare will cover a certain amount for up to one pair of eyeglasses or contact lenses for a patient who has undergone cataract surgery with an intraocular lens implant. HCPCS Level II code V2020 (Frames, purchases) covers the supply of the standard frame. If the patient wants a “deluxe frame” — one that costs more than the durable medical equipment (DME) payment for the standard frame — you can bill for the difference in cost with V2025 (Deluxe frame).

Example: If Medicare will reimburse $100 for frames, but the patient selects a $150 frame, you would report:

• V2020: $100
• V2025: $50

Do this: Have the patient sign an advance beneficiary notice (ABN) and append modifier GA (Waiver of liability statement issued as required by payer policy, individual case) to code V2025.