Wiki medically necessary fit

[dalanicks@aol.com]

Hello, one of my providers would like to clarify about dispensing medically necessary lenses. She wants to know if we can submit the Medically Necessary fit after the lenses are dispensed or does she have to wait until the fit is completed (typically this is 4-6 visits after the lens are dispensed.
This 4-6 visits are typically a no charge. Any information would be appreciated. i told her that she can submit the fit before its completed, but I would like some clarity

Thank you

 

[Cheezum51]

Most offices do submit claims for those fees before the fitting process is completed. I'm assuming that the up front fees billed for this service are substantial enough to cover the post dispensing progress checks. If not, most offices will bill a 92012 office visit code for each progress check.

Tell your doc to look at it this way. She has already spent valuable time doing the initial exam and fitting evaluation and also for the CL materials before the dispensing is even done. Then more time for the dispensing and contact lens insertion and removal training. Why wait at least a couple of months to be reimbursed for those substantial services and costs?

Tom Cheezum, OD, CPC, COPC

 

[dalanicks@aol.com]

Most offices do submit claims for those fees before the fitting process is completed. I'm assuming that the up front fees billed for this service are substantial enough to cover the post dispensing progress checks. If not, most offices will bill a 92012 office visit code for each progress check.

Tell your doc to look at it this way. She has already spent valuable time doing the initial exam and fitting evaluation and also for the CL materials before the dispensing is even done. Then more time for the dispensing and contact lens insertion and removal training. Why wait at least a couple of months to be reimbursed for those substantial services and costs?

Tom Cheezum, OD, CPC, COPC

Thank you Dr. Cheezum, that's what I thought, submit the fit so we can get paid, she didn't know if your suppose to submit it when done, but I agree with you. we just want to do anything wrong,

 

[dalanicks@aol.com]

Thank you Dr. Cheezum, that's what I thought, submit the fit so we can get paid, she didn't know if your suppose to submit it when done, but I agree with you. we just want to do anything wrong,

Hi Dr. Cheezum

Sorry to keep bothering you with questions but I know you know your information on this stuff. So my provider who is a chief in the contact lens department said that she thinks certain vision plans, ex. March vision, davis, may have "post op visits" for medically necessary contact lens if they have issues with the fits, I told her I don't think they do. It goes by CPT but would you know off hand if they do and if so where I can find the information. thank you so much, laura

 

[Cheezum51]

Each plan may be different. I know that VSP includes follow up/progress checks within the fee they pay providers for medically necessary contacts. Since all of the plans require preapproval, I believe your best source of information would be to get the specifics from each company when you request approval for them to cover the materials and fitting process. The website for the various plans may have some information as to what specifically their fee covers.
I'll check with a friend about Davis Vision specifically and get back to you.

Tom Cheezum, OD, CPC, COPC

 

[Cheezum51]

Just got info on Davis. Here, in Virginia, they pay $600 for fitting, one pair of standard gas permeable contacts and follow up visits. If anything other than a standard GP lens is needed, the patient pays the difference out of pocket.

Tom Cheezum, OD, CPC, COPC

 

[dalanicks@aol.com]

Just got info on Davis. Here, in Virginia, they pay $600 for fitting, one pair of standard gas permeable contacts and follow up visits. If anything other than a standard GP lens is needed, the patient pays the difference out of pocket.

Tom Cheezum, OD, CPC, COPC

hi, thank you for that, yes that is what I figured, about how many visits each plan is allowing for the fit. I will try with one or two of the plans first, but as you know a lot of the reps don't know much on the phone. I had to explain telemedicine to one rep, she didn't know what it was and how to handle the claim! thank you for your input as always