Optometry Coding & Billing Alert

Question: We are fitting quite a few of our keratoconus patients with a new type of contact lens, billing 92070 x 2 with the RT and LT modifiers. CPT 2005 defines this code as "Fitting of contact lens for treatment of disease, including supply of lens." I recently billed a private carrier with a fee of about $250 each eye/lens. The carrier paid us $61.95 per eye/lens, which doesn't even cover our cost of the lens. What can I do about this?


Mississippi Subscriber

Answer: Report 92310 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia) for the contact lens services and an appropriate code from the series V2500-V2599 (Contact lens ...) for the supplies.

Many insurance companies seem not to understand the costs involved in a keratoconus case. Code 92070 is often underpaid for what optometrists do because of the wide variability of the price of a contact lens.

Many offices provide lenses ranging in price from less than $45 to more than $180 each. Yet there are only limited CPT codes to cover contacts. One code cannot cover such a wide range of products, so try to bill services and materials separately.

Even then, the V codes cannot accurately describe the reasons and costs involved with some of the newer materials.

Try to find out what the insurance company will allow and then explain to the patient what his options are. Let your patient decide whether you will provide only what the insurance company will allow, or do what is best for your patient and let him pay the difference.

Do this: Call the private carrier and see if it has its own recommended way of billing for these lenses, since such low reimbursement is not fair. You might also consider calling the American Optometric Association and getting input from their representative for third-party insurance. If all else fails, file a complaint with your state board of insurance.