Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Transmittal Letter VIS-39 February 2011 TO: Vision Care Providers Participating in MassHealth FROM: Terence G. Dougherty, Medicaid Director RE: Vision Care Manual (2011 HCPCS) This letter transmits revisions to the service codes in the Vision Care Manual. The Centers for Medicare & Medicaid Services (CMS) have revised the Healthcare Common Procedure Coding System (HCPCS) for 2011. The revised Subchapter 6 is effective for dates of service on or after January 1, 2011. For dates of service on or after January 1, 2011, you must use the new codes in order to obtain reimbursement. Effective January 1, 2011, the consultation codes are no longer recognized by MassHealth for payment. Providers should code patient evaluation and management (E/M) visits with E/M codes that represent where the visit occurs, and that identify the complexity of the visit performed. In the office or other outpatient setting where a consultation is performed, providers should use the most appropriate E/M codes (99201 – 99205; 99211 – 99215), depending on the complexity of the visit and whether the patient is a new or established patient. In the inpatient hospital and nursing facility setting, all providers who perform an initial consultation may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304 – 99306). If you wish to obtain a fee schedule, you may download the Division of Health Care Finance and Policy (DHCFP) regulations at no cost at www.mass.gov/dhcfp. You may also purchase a paper copy of Division of Health Care Finance and Policy regulations from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below). You must contact them first to find out the price of the paper copy of the publication. The regulation title for vision care services is 114.3 CMR 15.00: Vision Care Services and Ophthalmic Materials. Massachusetts State Bookstore State House, Room 116 Boston, MA 02133 Telephone: 617-727-2834 www.mass.gov/sec/sprDivision of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Telephone: 617-988-3100 www.mass.gov/dhcfp MassHealth Web Site This transmittal letter and attached pages are available on the MassHealth Web site at www.mass.gov/masshealth. Questions If you have any questions about this transmittal letter, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Vision Care Manual Pages vi, vii, and 6-1 through 6-12 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Vision Care Manual Pages vi and 6-1 through 6-12 — transmitted by Transmittal Letter VIS-37 Page vii — transmitted by Transmittal Letter VIS-35 Pages 6-13 and 6-14 — transmitted by Transmittal Letter VIS-38 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title Table of Contents Page vi Vision Care Manual Transmittal Letter VIS-39 Date 01/01/11 6. Service Codes and Descriptions Definitions............................................................................................................................ 6-1 Explanation of Abbreviations ............................................................................................... 6-2 Service Codes and Descriptions: Visual Analysis ............................................................... 6-2 Service Codes and Descriptions: Supplementary Testing ................................................... 6-9 Service Codes and Descriptions: Contact Lenses ................................................................ 6-10 Service Codes and Descriptions: Contact Lens Services ..................................................... 6-11 Service Codes and Descriptions: Dispensing of Ophthalmic Materials: Fitting of Prescription Spectacles, Glass/Plastic Lenses ................................................................ 6-11 Service Codes and Descriptions: Dispensing of Ophthalmic Materials: Repairs and Replacement Parts ................................................................................................... 6-11 Service Codes and Descriptions: Miscellaneous ................................................................. 6-12 Appendix A. Directory .................................................................................................................. A-1 Appendix B. Enrollment Centers................................................................................................... B-1 Appendix C. Third-Party-Liability Codes ..................................................................................... C-1 Appendix W. EPSDT Services: Medical and Dental Protocols and Periodicity Schedules........... W-1 Appendix X. Family Assistance Copayments and Deductibles .................................................... X-1 Appendix Y. EVS Codes/Messages .............................................................................................. Y-1 Appendix Z. EPSDT/PPHSD Screening Services Codes ............................................................. Z-1 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title Preface Page vii Vision Care Manual Transmittal Letter VIS-39 Date 01/01/11 The regulations and instructions governing provider participation in MassHealth are published in the Provider Manual Series. MassHealth publishes a separate manual for each provider type. Manuals in the series contain administrative regulations, billing regulations, program regulations, service codes, administrative and billing instructions, and general information. MassHealth regulations are incorporated into the Code of Massachusetts Regulations (CMR), a collection of regulations promulgated by state agencies within the Commonwealth and by the Secretary of State. MassHealth regulations are assigned Title 130 of the Code. Pages that contain regulatory material have a CMR chapter number in the banner beneath the subchapter number and title. Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR Chapter 450.000. These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals. Program regulations cover matters that apply specifically to the type of provider for which the manual was prepared. For vision care providers, those matters are covered in 130 CMR Chapter 402.000, reproduced as Subchapter 4 in the Vision Care Manual. Revisions and additions to the manual are made as needed by means of transmittal letters, which furnish instructions for substituting, adding, or removing pages. Some transmittal letters will be directed to all providers; others will be addressed to providers in specific provider types. In this way, a provider will receive all those transmittal letters that affect its manual, but no others. The Provider Manual Series is intended for the convenience of providers. Neither this nor any other manual can or should contain every federal and state law and regulation that might affect a provider's participation in MassHealth. The provider manuals represent instead MassHealth’s effort to give each provider a single convenient source for the essential information providers need in their routine interaction with MassHealth and its members. 601 Introduction MassHealth pays for the services represented by the codes listed in Subchapter 6 in effect at the time of service, subject to all conditions and limitations in MassHealth regulations at 130 CMR 402.000 and 450.000. A vision care provider may request prior authorization for any medically necessary service reimbursable under the federal Medicaid Act in accordance with 130 CMR 450.144, 42 U.S.C. §§ 1396d(a)(4)(B), and 42 U.S.C. § 1396d(r)(5) for a MassHealth Standard or CommonHealth member younger than 21 years of age, even if it is not designated as covered or payable in Subchapter 6 of the Vision Care Manual. 602 Definitions The following terms used in Subchapter 6 shall have the meanings given below. (A) Consultation — a type of service provided by a physician or an optometrist whose opinion or advice about the evaluation or management of a specific problem is requested by a physician, optometrist, or other appropriate source. (1) A consultant may initiate diagnostic or therapeutic services, or both. (2) The request for a consultation from the attending physician, optometrist, or other appropriate source and the need for consultation must be documented in the patient's medical record. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated to the requesting physician or other appropriate source. (3) Any procedure identified with a specific CPT code and performed on or subsequent to the date of the initial consultation should be reported separately. If a consultant subsequently assumes responsibility for management of a portion or all of the patient's conditions, the consultation codes should not be used. (B) Established Patient — a patient who has received professional services from the physician or optometrist within the past three years. (C) New Patient — a patient who has not received any professional services from the physician or optometrist within the past three years. (D) Ophthalmological Service Levels (1) Intermediate Services — a level of service pertaining to the evaluation of a new or existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis, including history, general medical observation, external ocular and adnexal examination, and other diagnostic procedures as indicated; may include the use of mydriasis. Intermediate services do not usually include determination of the refractive state but may do so in an established patient who is under continuing active treatment. For example: (a) review of history, external examination, ophthalmoscopy, biomicroscopy for an acute complicated condition (for example, iritis) not requiring comprehensive ophthalmological services; and (b) review of interval history, external examination, ophthalmoscopy, biomicroscopy, and tonometry in an established patient with a known cataract not requiring comprehensive ophthalmological services. (2) Extended Services — a level of service requiring an unusual amount of effort or judgment, including a detailed history, review of medical records, examination, and a formal conference with patient, family, or staff, or a comparable medical diagnostic and/or therapeutic service. 602 Definitions (cont.) (3) Comprehensive Services — a level of service in which a general evaluation of the complete visual system is made. The comprehensive services constitute a single service entity but need not be performed at one session. The service includes history, general medical observation, external and ophthalmoscopic examination, gross visual fields, and basic sensorimotor examination. It often includes, as indicated: biomicroscopy, examination with cycloplegia or mydriasis, and tonometry. It always includes initiation of diagnostic and treatment programs as indicated. For example: the comprehensive services required for diagnosis and treatment of a patient with symptoms indicating possible disease of the visual system, such as glaucoma, cataract or retinal disease, or to rule out disease of the visual system, new or established patient. 603 Explanation of Abbreviations The following abbreviations are used in Subchapter 6. (A) “IC” indicates that the claim will receive individual consideration to determine payment. (See 130 CMR 402.407.) (B) “PA” indicates that prior authorization is required. (See 130 CMR 402.408.) (C) “SP” is an abbreviation for separate procedure, and indicates that the procedure is commonly performed as an integral part of a total service and, as such, does not usually warrant a separate fee. The procedure must be performed alone for a specific purpose to receive the separate fee. (See 130 CMR 402.409.) 604 Service Codes and Descriptions: Visual Analysis Use Modifier 52 (reduced services) when billing for eye examinations performed without cycloplegic or mydriatic drops. Service Code Service Description EVALUATION AND MANAGEMENT (E/M) SERVICES – OPTOMETRISTS ONLY Office or Other Outpatient E/M Visits: New Patient 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - a problem-focused history; - a problem-focused examination; and - straightforward medical decision making Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 604 Service Codes and Descriptions: Visual Analysis (cont.) Service Code Service Description 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - an expanded problem-focused history; - an expanded problem-focused examination; and - straightforward medical decision making Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - a detailed history; - a detailed examination; and - medical decision making of low complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - a comprehensive history; - a comprehensive examination; and - medical decision making of moderate complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 604 Service Codes and Descriptions: Visual Analysis (cont.) Service Code Service Description Office or Other Outpatient E/M Visits: Established Patient 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: - a problem-focused history; - a problem-focused examination; - straightforward medical decision making Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: - an expanded problem-focused history; - an expanded problem-focused examination; - medical decision making of low complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: - a detailed history; - a detailed examination; - medical decision making of moderate complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: - a comprehensive history; - a comprehensive examination; - medical decision making of high complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 604 Service Codes and Descriptions: Visual Analysis (cont.) Service Code Service Description Nursing Facility E/M Visits: New or Established Patient 99304 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: - a detailed or comprehensive history; - a detailed or comprehensive examination; and - medical decision making that is straightforward or of low complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver. 99305 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: - a comprehensive history; - a comprehensive examination; and - medical decision making of moderate complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 35 minutes with the patient and/or family or caregiver. 99306 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver. 99307 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: - a problem focused interval history; - a problem focused examination; and - straightforward medical decision making Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 10 minutes with the patient and/or family or caregiver. 604 Service Codes and Descriptions: Visual Analysis (cont.) Service Code Service Description 99308 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: - an expanded problem focused interval history; - an expanded problem focused examination; and - medical decision making of low complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 15 minutes with the patient and/or family or caregiver. 99309 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: - a detailed interval history; - a detailed examination; and - medical decision making of moderate complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient has developed a significant complication or a significant new problem. Physicians typically spend 25 minutes with the patient and/or family or caregiver. 99310 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: - a comprehensive interval history; - a comprehensive examination; and - medical decision making of high complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 35 minutes with the patient and/or family or caregiver. Domiciliary or Rest Home E/M Visits: New or Established Patient 99328 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes with the patient and/or family or caregiver. 604 Service Codes and Descriptions: Visual Analysis (cont.) Service Code Service Description 99337 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: - a comprehensive interval history; - a comprehensive examination; and - medical decision making of moderate to high complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes with the patient and/or family or caregiver. Home Services 99341 Home visit for the evaluation and management of a new patient, which requires these 3 key components: - a problem focused history; - a problem focused examination; and - straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 99342 Home visit for the evaluation and management of a new patient, which requires these 3 key components: - an expanded problem focused history; - an expanded problem focused examination; and - medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 99343 Home visit for the evaluation and management of a new patient, which requires these 3 key components: - a detailed history; - a detailed examination; and - medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family. 604 Service Codes and Descriptions: Visual Analysis (cont.) Service Code Service Description 99344 Home visit for the evaluation and management of a new patient, which requires these 3 key components: - a comprehensive history; - a comprehensive examination; and - medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 99347 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: - a problem focused interval history; - a problem focused examination; and - straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 99348 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: - an expanded problem focused interval history; - an expanded problem focused examination; and - medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 99349 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: - a detailed interval history; - a detailed examination; and - medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 604 Service Codes and Descriptions: Visual Analysis (cont.) Service Code Service Description OPHTHALMOLOGICAL OR OTHER SERVICES PROVIDED DURING AN E/M VISIT, NEW OR ESTABLISHED PATIENT – OPTOMETRISTS ONLY 67820 Correction of trichiasis; epilation, by forceps only 92002 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient 92004 comprehensive, new patient, one or more visits 92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient 92014 comprehensive, established patient, one or more visits 92015 Determination of refractive state 605 Service Codes and Descriptions: Supplementary Testing Service Code Service Description SUPPLEMENTARY TESTING – OPTOMETRISTS ONLY 92065 Orthoptic and/or pleoptic training, with continuing medical direction and evaluation (PA) 92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent) 92082 intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33) 92083 extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30ş, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2) 92100 Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure) (SP) 92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral; 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve 92134 retina 605 Service Codes and Descriptions: Supplementary Testing (cont.) Service Code Service Description SUPPLEMENTARY TESTING – LEVEL II AND LEVEL III OPTOMETRISTS ONLY 76512 Ophthalmic ultrasound, diagnostic; contact B-scan (with or without simultaneous A-scan) 76513 anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy 76514 corneal pachymetry, unilateral or bilateral (determination of corneal thickness) 92020 Gonioscopy (separate procedure) (SP) 92120 Tonography with interpretation and report, recording indentation tonometer method or perilimbal suction method 92130 Tonography with water provocation 92140 Provocative tests for glaucoma, with interpretation and report, without tonography 92225 Ophthalmoscopy, extended with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; initial 92226 subsequent 92227 Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral 92228 Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral 92250 Fundus photography with interpretation and report (PA) (Both eyes equal one unit.) 92260 Ophthalmodynamometry 92275 Electroretinography with interpretation and report 92285 External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography) 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording 92542 Positional nystagmus test, minimum of four positions, with recording 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording 606 Service Codes and Descriptions: Contact Lenses Service Code Service Description CONTACT LENSES – OPTICIANS AND OPTOMETRISTS ONLY V2500 Contact lens, PMMA, spherical, per lens V2501 Contact lens, PMMA, toric or prism ballast, per lens V2503 Contact lens, PMMA, color vision deficiency, per lens (PA) V2510 Contact lens, gas permeable, spherical, per lens V2511 Contact lens, gas permeable, toric, prism ballast, per lens (PA) V2512 Contact lens, gas permeable, bifocal, per lens (PA) V2520 Contact lens, hydrophilic, spherical, per lens V2521 Contact lens, hydrophilic, toric or prism ballast, per lens (PA) V2522 Contact lens, hydrophilic, bifocal, per lens (PA) V2599 Contact lens, other type (PA) (IC) 607 Service Codes and Descriptions: Contact Lens Services Service Code Service Description CONTACT LENS PROFESSIONAL SERVICES – OPTICIANS AND OPTOMETRISTS ONLY 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 (IC) 92326 Replacement of contact lens 608 Service Codes and Descriptions: Dispensing of Ophthalmic Materials: Fitting of Prescription Spectacles, Glass/Plastic Lenses Service Code Service Description FITTING OF SPECTACLES – ACUTE HOSPITALS, COMMUNITY HEALTH CENTERS, OPHTHALMOLOGISTS, OPTICIANS, AND OPTOMETRISTS ONLY 92340 Fitting of spectacles, except for aphakia; monofocal (use for dispensing entire new initial eyeglasses, or entire new replacement eyeglasses, frame with lenses) 92341 bifocal (use for dispensing entire new initial eyeglasses, or entire new replacement eyeglasses, frame with lenses) 92342 multifocal, other than bifocal (use for dispensing entire new initial eyeglasses, or entire new replacement eyeglasses, frame with lenses) 609 Service Codes and Descriptions: Dispensing of Ophthalmic Materials: Repairs and Replacement Parts REPAIRS AND REPLACEMENT PARTS – ACUTE HOSPITALS, COMMUNITY HEALTH CENTERS, OPHTHALMOLOGISTS, OPTICIANS, AND OPTOMETRISTS ONLY Service Code-Modifier Service Description 92340-RB Fitting of spectacles, except for aphakia; monofocal – Replacement and repair (use for dispensing replacement single vision lens, glass or plastic, including cataract lenses, per lens) 92341-RB bifocal – Replacement and repair (use for dispensing replacement bifocal lens, glass or plastic, including cataract lenses, per lens) 92342-RB multifocal, other than bifocal – Replacement and repair (use for dispensing replacement multifocal lens, other than bifocal, glass or plastic, including cataract lenses, per lens) 92370 Repair and refitting spectacles; except for aphakia (use for dispensing a replacement frame only, or any replacement frame components such as hinges or temples) 610 Service Codes and Descriptions: Miscellaneous Service Code Service Description MISCELLANEOUS – OCULARISTS, OPHTHALMOLOGISTS, OPTICIANS, AND OPTOMETRISTS 99173 Screening test of visual acuity, quantitative, bilateral (use for titmus vision test) T2002 Nonemergency transportation, per diem (once per member per date of service for each member for whom the provider delivered or picked up eyeglasses, or to whom vision care services were provided out of the office) V2799 Vision service, miscellaneous (PA) (IC) MISCELLANEOUS – OPHTHALMOLOGISTS, OPTICIANS, AND OPTOMETRISTS ONLY V2600 Hand-held low-vision aids and other nonspectacle-mounted aids (PA) (IC) V2610 Single-lens spectacle-mounted low-vision aids (PA) (IC) V2615 Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes, and compound microscopic lens system (PA) (IC) MISCELLANEOUS – OCULARISTS ONLY V2623 Prosthetic eye, plastic, custom (IC) V2624 Polishing/resurfacing of ocular prosthesis (IC) V2625 Enlargement of ocular prosthesis (IC) V2626 Reduction of ocular prosthesis (IC) V2627 Scleral cover shell (IC) V2628 Fabrication and fitting of ocular conformer (IC) V2629 Prosthetic eye, other type (PA) (IC) This publication contains codes that are copyrighted by the American Medical Association. Certain terms used in the service descriptions for HCPCS codes are defined in the Physician's Current Procedural Terminology (CPT) code book.