Well Vison Codes
 
  1. BulletS0620  Routine eye exam including refraction new patient (Level II HCPCS code)

  2. BulletS0621  Routine eye exam including refraction estb. patient (Level II HCPCS code)

  3. BulletS9986  Wellness level II HCPCS screening code - can be used at the providers discretion for optomap, Gdx, FDT, fundus photography and other wellness screenings to facilitate proper adjudication of screening vs diagnostic codes.

  4. Bullet92310 contact lens fitting except for aphakia  This code can be used for most contact lens patients.  I have 5 levels of this code to differentiate the level of care.  See PlanoEye.com

  5. Bullet92004, 92014, 92002, 92012 can be used for wellness exam as required by some carriers.  Be sure to utilize a  wellness ICD code (myopia, hyperopia, astigmatism, presbyopia, emmetropia) when billing with the CPT code when the purpose for the exam is routine, preventative or wellness.  If you inadvertently bill a medical ICD code you may get paid a higher amount that can cause problems in post payment reviews. 

  6. BulletA best practice for insurance verification is to verify both Vision and Medical plan benefits prior to the patients visit.  Alternately insurance verification can be done upon patient arrival.  Information on eligibility, deductibles, co-payments and whether the office visit is subject to deductible can be done online or telephone.  This allows collection of  patient balance prior to patient departure. 

Many carriers require and/or allow 92XXX and/or 99XXX E&M codes to designate routine eye exams and will reimburse the proper amount based on the diagnosis billed.  Well vision diagnosis will yield well vision reimbursement,  Medial diagnosis will yield medical reimbursement.  Be sure to utilize a  wellness ICD code (myopia, hyperopia, astigmatism, presbyopia, emmetropia) with the CPT code when the purpose for the exam is routine, preventative or wellness.  If you inadvertently bill a medical ICD code as the reason for the visit you may get paid a higher amount that can cause problems in post payment reviews. 

Moreover some carriers Provide medical and well vision care benefits and can be provided on the same day when necessary.

Example: Blue cross blue shield & patient has routine exam and medical benefits.  Patient presents with flashes and floaters and also need a glasses Rx.

92004  Medical eye exam for ICD 379.21 PVD..............................$150 billed to BCBS

92015  Refraction for ICD 367.1  Myopia.......................................$ 50 billed to BCBS*

92250  Fundus photography for ICD 361.31 Retinal hole...............$ 75 billed to BCBS

If the patient is not eligible for wellness eye exam benefit this non covered item can be billed to the patient.


Example:  Blue cross blue shield & patient has routine exam and medical benefits.  Patient presents with flashes and floaters and also need a glasses and contact lens Rx.

92004  Medical eye exam for ICD 379.21 PVD..............................$150 billed to BCBS

92015  Refraction for ICD 367.1  Myopia.......................................$ 50 billed to BCBS*

92250  Fundus photography for ICD 361.31 Retinal hole...............$ 75 billed to BCBS

92310  Contact lens exam for ICD 367.1  Myopia..........................$100 to patient if non covered to BCBS if covered

If the patient is not eligible for wellness eye exam benefit this non covered item can be billed to the patient.