Covered vision procedures are identified by the CPT or HCPCS procedure codes and modifiers listed on the interactive maximum allowable fee schedule. Maximum allowable fee information is updated routinely.
CPT or HCPCS procedure codes, and modifiers as appropriate, are required on all 1500 Health Insurance Claim Forms for vision services. Vision claims without CPT or HCPCS procedure codes are denied.
Optometrists and ophthalmologists may be reimbursed for services related to the dispensing and repair of vision materials, as well as for covered diagnostic and surgical services. Optometrists must have a TPA certificate to be reimbursed for certain surgical procedures.
Opticians may be reimbursed for services pertaining to the supply, dispensing, and repair of vision materials.
Ophthalmologists also may be reimbursed for procedure codes listed within the physician service area.
The following tables list vision care procedure codes that may be billed with a modifier, when appropriate.
| CPT Procedure Codes | Description | Allowable Modifiers |
|---|---|---|
| 66820–66988 | Components of cataract surgery | 54, 55 |
| 67221 | Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion) | 50 |
| 68761 | Closure of the Lacrimal punctum; by plug, each | 50 (both lower eyelids), E1, E2, E3, E4 |
| 92340–92353 | Ophthalmology; Spectacle Services (including prosthesis for aphakia) | UA, U5, U6, U9 |
| HCPCS Procedure Codes | Description | Allowable Modifiers |
|---|---|---|
| S0504–S0510 (For requesting PA only) | Safety lenses | SC |
| S0516 (For requesting PA only) | Safety glass frames | SC |
| V2020 | Frames, purchases | SC, U4, U7 |
| V2100–V2118 | Vision Services; Single Vision, Glass or Plastic | SC, U1 |
| V2199 | Not otherwise classified, single vision lens | SC, U1 |
| V2200–V2219 | Vision Services; Bifocal, Glass or Plastic | SC, U2 |
| V2220 | Bifocal add over 3.25d | SC, U2 |
| V2221 | Lenticular lens, per lens, bifocal | SC |
| V2299 | Specialty bifocal (by report) | SC, U2 |
| V2300–V2320 | Vision Services; Trifocal, Glass or Plastic | SC, U2 |
| V2321 | Lenticular lens, per lens, trifocal | SC |
| V2399 | Specialty trifocal (by report) | SC, U2 |
| V2744 | Tint, photochromatic, per lens | SC |
| V2755 | U-V lens, per lens | SC |
| V2780 | Oversize lens, per lens | SC |
| V2781 | Progressive lens, per lens | SC |
| V2784 | Lens, polycarbonate or equal, any index, per lens | SC |
| V2799 | Vision item or service, miscellaneous | SC |