Submitting Claims/Billing & Reimbursement
Submit claims just as you do for VSP Signature Plan claims. For additional information, refer to Submitting Claims in the VSP Manual.
Billing
- You may bill eye exams using S0620 (routine ophthalmological examination, including refraction, new patient) or S0621 (routine ophthalmological examination, including refraction, established patient). Be sure to complete a comprehensive exam when using these codes; VSP pays at the comprehensive level.
- If you choose to use 920XX codes to bill the eye exam, please remember to bill refraction (92015) separately for accurate reimbursement.
- WellVision® Exams should be billed with the appropriate refractive error diagnosis code. Reasons for encounters diagnosis codes are also acceptable.
- Reasons for encounters diagnosis codes are payable for WellVision® Exams only. Reasons for encounters diagnosis codes may not be billed as primary or as the sole diagnosis code for materials.
- Materials must be billed with the appropriate refractive error diagnosis code.
- Enter additional diagnosis codes if other medical conditions exist.
- Bill non-covered materials on a private invoice, even if a VSP contract lab is used. Non-covered lenses may be fabricated at any lab of your choice, including in-office labs.
Note:
When billing progressive lenses, bill your U&C fee on two lines—one for the base bifocal lenses and the second for the progressive add-on.
Reimbursement
Reimbursement is made according to the current Advantage Network Fee Schedule. View the Advantage Network Fee Schedule on VSPOnline by selecting Administration and Practice/Doctor Updates from the menu, then clicking the View or Update Fees link.
Note:
Only Practice Administrators can view the Professional Fee Schedules. If you aren’t able to access the fee schedule, contact Eyefinity at 877.448.0707.
Refractive Error Diagnosis Codes
|
Code: |
|
|---|---|
|
H52.01 |
Hypermetropia, right eye |
|
H52.02 |
Hypermetropia, left eye |
|
H52.03 |
Hypermetropia, bilateral |
|
H52.11 |
Myopia, right eye |
|
H52.12 |
Myopia, left eye |
|
H52.13 |
Myopia, bilateral |
|
H52.201 |
Unspecified astigmatism, right eye |
|
H52.202 |
Unspecified astigmatism, left eye |
|
H52.203 |
Unspecified astigmatism, bilateral |
|
H52.211 |
Irregular astigmatism, right eye |
|
H52.212 |
Irregular astigmatism, left eye |
|
H52.213 |
Irregular astigmatism, bilateral |
|
H52.221 |
Regular astigmatism, right eye |
|
H52.222 |
Regular astigmatism, left eye |
|
H52.223 |
Regular astigmatism, bilateral |
|
H52.31 |
Anisometropia |
|
H52.32 |
Aniseikonia |
|
H52.4 |
Presbyopia |
|
H52.511 |
Internal ophthalmoplegia (complete) (total), right eye |
|
H52.512 |
Internal ophthalmoplegia (complete) (total), left eye |
|
H52.513 |
Internal ophthalmoplegia (complete) (total), bilateral |
|
H52.521 |
Paresis of accommodation, right eye |
|
H52.522 |
Paresis of accommodation, left eye |
|
H52.523 |
Paresis of accommodation, bilateral |
|
H52.531 |
Spasm of accommodation, right eye |
|
H52.532 |
Spasm of accommodation, left eye |
|
H52.533 |
Spasm of accommodation, bilateral |
|
H52.6 |
Other disorders of refraction |
|
H52.7 |
Unspecified disorder of refraction |
Reasons for Encounters Diagnosis Codes
Reasons for encounters diagnosis codes are payable for WellVision® Exams only. Reasons for encounters diagnosis codes may not be billed as primary or as the sole diagnosis code for materials.
|
Code: |
|
|---|---|
|
Z01.00 |
Encounter for examination of eyes and vision without abnormal findings |
|
Z01.01 |
Encounter for examination of eyes and vision with abnormal findings |
|
Z01.020 |
Encounter for examination of eyes and vision following failed vision screening without abnormal findings |
|
Z01.021 |
Encounter for examination of eyes and vision following failed vision screening with abnormal findings |
|
Z13.5 |
Encounter for screening for eye and ear disorders |
|
Z46.0 |
Encounter for fitting and adjustment of spectacles and contact lenses |
|
Z82.1 |
Family history of blindness and visual loss |
|
Z83.511 |
Family history of glaucoma |
|
Z83.518 |
Family history of other specified eye disorder |