Ophthalmology and Optometry Coding Alert

Question: How would I go about coding for a progressive bifocal to those plans that pay for materials? HCPCS Level II code V2781 only mentions progressive lenses, not bifocals.

Louisiana Subscriber

Answer: CMS advises eye care practices to code progressive lenses on two lines. On the first line, report the appropriate code for the bifocal (V2200-V2299) or trifocal (V2300-V2399). “When billing claims for progressive lenses, use the appropriate code for the standard bifocal … lenses and a second line item using code V2781 for the difference between the charge for the progressive lens and the standard lens,” CMS says in Policy Article A52499, which was last updated in October 2020.

On the second line, report V2781 (Progressive lens, per lens) for the difference between the progressive lens and the standard bifocal/trifocal.

Example: The patient chooses a progressive lens with a cost of $100 per lens ($200 for the pair of lenses). Your retail charge for a standard bifocal lens is $45 ($90 for the pair). Report V2200 (Sphere, bifocal, plano to plus or minus 4.00d, per lens) on the first line, with your standard charge of $90. Report V2781 on the second line with a charge of $110 ($200-$90).

Best bet: Check with private carriers for their preferred methods. Insurance plans have their own way of coding for materials, and they can vary significantly from one payer to the next.

Don’t forget: A Medicare patient is entitled to one standard pair of glasses after each cataract surgery with an IOL implant.

The refraction is not covered, even though the glasses are. The law provides a maximum benefit to Medicare beneficiaries of no more than “one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens.”