Follow these tips when billing vision claims

We’re providing you with updated tips for billing vision claims. These guidelines don’t apply to Blue Cross Blue Shield of Michigan products that use VSP.

Eligibility

• Remember to check the patient’s vision care benefit. Coverage may vary under different contracts and for different groups. If there’s a difference between what’s described in our provider manual and the patient’s Blue Cross contract, the contract applies.

Claims submission

• You can submit your vision claims electronically.

Progressive lenses

• Verify whether your patient has the progressive lens benefit before providing services. Call PARS, our automated benefits and eligibility information system, at 1-800-482-4047 to verify the benefit.

• If progressive lenses are covered under the patient’s vision benefit, use code V2781 and report the total lens charge. Submit your total charge for both lenses on a single service line. If billing one lens, adjust your charge accordingly.

• Blue Cross doesn’t reimburse for the progressive lens charge in addition to the spectacle lens fee. Please bill either the progressive lens or the spectacle lens, but not both.

• If progressive lenses aren’t covered under the patient’s vision benefit, use the appropriate code for the bifocal or trifocal lens. In addition, use procedure code S1001 to bill the difference in charges between the progressive lenses and the bifocal or trifocal lenses.

Miscellaneous or NOC procedure codes

• When billing a miscellaneous vision service for which there is no HCPCS code, use procedure code V2799. Remember to submit supporting documentation. Claims for this service will be rejected without supporting documentation. Note: Submitting documentation with this procedure code doesn’t guarantee payment.

Routine vision

• Use the following codes when billing routine vision (nonmedical) examinations and comprehensive contact lens evaluations:
• S0592
• S0620
• S0621
• *92015

Since vision exam codes S0620 and S0621 include refraction, procedure code *92015 isn’t payable as a separate benefit.

Medical diagnoses

When billing claims with the diagnosis codes below, vision care services (except S0620, S0621 and *92015) will be processed under the medical program.

H52.31 Anisometropia
H52.32 Aniseikonia
H18.601 Keratoconus, unspecified, right eye
H18.602 Keratoconus, unspecified, left eye
H18.603 Keratoconus, unspecified, bilateral
H18.609 Keratoconus, unspecified, unspecified eye
H18.611 Keratoconus, stable, right eye
H18.612 Keratoconus, stable, left eye
H18.613 Keratoconus, stable, bilateral eye
H18.619 Keratoconus, stable, unspecified eye
H18.621 Keratoconus, unstable, right eye
H18.622 Keratoconus, unstable, left eye
H18.623 Keratoconus, unstable, bilateral
H18.629 Keratoconus, unstable, unspecified eye
H27.00 Aphakia, unspecified eye
H27.01 Aphakia, right eye
H27.02 Aphakia, left eye
H27.03 Aphakia, bilateral
Q12.3 Congenital aphakia
Z96.1 Presence of intraocular lens
Z98.41 Cataract extraction status, right eye (Use additional code to identify intraocular lens implant status Z96.1.)
Z98.42 Cataract extraction status, left eye (Use additional code to identify intraocular lens implant status Z96.1.)
Z98.49 Cataract extraction status, unspecified eye (Use additional code to identify intraocular lens implant status Z96.1.)