Proprietary Lens and Frame
Some proprietary products are available for use with VSP benefits under the Proprietary Lens and Frame Procedure. Please refer to the Guidelines below for information.
Guidelines
This isn’t a complete list of products. Please refer to the Product Index for a complete list.
|
Description |
Sample Products |
Guidelines |
|---|---|---|
|
Proprietary Genuine Brand Lens & Frame: Genuine brand name Rx lenses that must be sent to the frame company’s lab or a non-VSP contract lab |
Bollé |
For products listed in the Product Index as a proprietary lens and frame, see Proprietary Lens and Frame Orders. Products not listed in the Product Index aren’t covered. Call VSP at 800.615.1883 to verify coverage and receive billing instructions. |
|
Reproductions of genuine brand name lenses, that are produced in a contract lab |
Bollé |
Use a contract lab and applicable lens enhancement code(s). |
|
Proprietary Frame Mounting: Any frame and lens mounting combination that can’t be fabricated by a VSP contract lab |
Click 12—lenses |
For products listed in the Product Index as a proprietary lens and frame, see Proprietary Lens and Frame Orders. Products not listed in the Product Index aren’t covered. Call VSP at 800.615.1883 to verify coverage and receive billing instructions. |
|
Complicated lens/frame mounts that some contract labs can fabricate |
Air Titanium—notched lenses Lindberg Optic Design—lenses |
Use a contract lab and applicable lens enhancement code(s). |
|
Fitovers, or frames made specifically to fit over a pair of prescription eyeglasses |
Fitovers |
Covered only when glazed with prescription lenses. If your patient has plano benefits, a frame with plano lenses can be used. Otherwise, fitovers aren’t covered by VSP and handled privately. |
|
Readers |
Scojo Vision, LLC |
Readers are only covered if the generic lenses supplied with the frame are replaced with custom prescription lenses at the time of purchase. Otherwise, they’re not covered by VSP and should be handled as a private transaction. |
|
Diving masks when Rx-able lenses are glued directly into the mask |
This is not available for use with VSP benefits. If dispensed, VSP benefits can’t be applied to the lens OR frame. This is a private transaction between you and the patient. Do not submit claims to VSP for payment. |
|
|
General sports goggles with an adapter or insert in which a lab can fabricate and mount lenses relatively easilyIncludes diving masks with an adapter. |
Rec Specs Silhouette–Adidas |
Please use a contract lab and all applicable lens enhancement code(s). |
|
Clip-ons with frame, priced as one unit are considered a single frame. |
Handle this frame as you would any other frame. Enter the wholesale single unit price in wholesale frame cost box. If the frame is unlisted, enter the acquisition cost in the wholesale frame cost box. |
|
|
Clip-ons priced separately from frame. |
These are not covered by VSP and constitute a private transaction between the doctor and patient. |
Proprietary Lens and Frame Orders
The two products available to process as a private order for proprietary lens and frame order are:
- Genuine brand name RX lenses that must be sent to the frame company’s lab or a non-VSP contract lab.
- Frame and lens mounting that can’t be fabricated at a VSP contract lab.
Check the Product Index to see if a product is available as a proprietary lens and frame.
Billing Procedures for Proprietary Lens and Frame Orders
Important!
This is only available for genuine brand name RX lenses that must be sent to the frame company’s lab or a non-VSP contract lab and frame and lens mounting that can’t be fabricated at a VSP contract lab.
Charge your patient 80% of your U&C fee, minus the lens allowance and your scheduled lens dispensing fee. Lens Enhancements normally covered for your patient aren’t covered under Proprietary Lens and Frame process.
Note:
Collect material, and/or lens copays as you normally would.
Calculating Patient Out-of-pocket Expenses
- Determine your U&C fee for the lens
- Deduct 20%.
- Subtract the RX lens allowance listed below
- Single Vision: $20
- Bifocal/Progressive: $35
- Trifocal: $45
- Subtract your assigned lens-dispensing fee available on your Assigned Fee Report on VSPOnline at eyefinity.com.
- Add applicable copays
The following table is an example you can use to calculate patient charges:
|
Calculating Patient Charges on Proprietary Lens and Frame Orders |
|
|---|---|
|
U&C fee for lens |
$ |
|
Deduct 20% |
- $ |
|
Subtotal |
$ |
|
Subtract VSP proprietary RX lens allowance |
- $ |
|
Subtract your assigned lens dispensing fee |
- $ |
|
Add any applicable copays collected from patient. |
$ |
|
Patient’s out-of-pocket expense |
$ |
Calculate the patient’s out-of-pocket expenses for frame as you normally would, according to section Providing Frames.
Submitting Proprietary Lens and Frame Order Claims
Electronic Claim Submission
Order proprietary lens and frame through eClaim at eyefinity.com:
- Choose the vision type (single vision, bifocal, etc.) in the pull-down menu.
- Choose the material type (plastic, glass, etc.) in the pull-down menu.
- Select “Proprietary Genuine Brand Lens & Frame” or “Proprietary Frame Mounting” as the lens choice.
- Choose Non IDC Lab Invoice. (Lab 0100 is allowed when tied to Proprietary Lens and Frame)
- Enter a comment in Box 19 on the CMS-1500 form that includes the lab’s private invoice cost and the product name:
- Continue normal claim submission
- EXAMPLE: Frame and Lens Mounting not available through a VSP Contract Lab – Non-VSP mounting Bolle - $500.50
- EXAMPLE: Genuine Brand RX lenses not available through a VSP Contract Lab – Genuine Brand RX Costa Del Mar - $500.50
Note:
Please keep a copy of the lab invoice for your files. We may ask for a copy if there’s a question about your submission.
Paper Claim Submission
Submit your patient’s claim form and the lab’s private invoice to VSP.
Enter a comment in Box 19 on the CMS-1500 form that includes the lab’s private invoice cost and the product name:
- EXAMPLE: Frame and Lens Mounting not available through a VSP Contract Lab – Non-VSP mounting Bolle - $500.50
- EXAMPLE: Genuine Brand RX lenses not available through a VSP Contract Lab – Genuine Brand RX Costa Del Mar - $500.50
Provider Reimbursement
We’ll reimburse you for the lens allowance, in addition to your scheduled lens dispensing fee and other fees that may apply.
First-Time Redos on Proprietary Lens and Frame Orders
First-time redos are a private transaction between you and the patient.