5.2 Visual Prosthetic Devices

Visual services are provided to correct or modify a visual condition and to provide the individual with maximum visual acuity given impairment and functional limitations. Professional diagnostic and treatment services include the provision of ocular prostheses and aphakic corrective lenses.

Low vision evaluations may include an Evaluation and Management procedure (such as CPT codes 99205 or 99215) in addition to determination of refractive state (CPT code 92015). Low vision follow-up services should be reported using CPT code 99213. Allowable fees for such services depend on the type of provider and are determined in accordance with the procedures provided in Chapter 1 of the Fee Schedule.

(Procedure codes 18000-52, 18000-53, 18000-54, 18000-55, 18000-56, 18000-57, 18000-58, 18000-59, 18000-60, 18000-61, 18000-62, 18000-63, 18000-64, 18500-01, 18500-02, 18500-03, 18500-07, 18500-08, 18500-09)

Corrective lenses must be prescribed in writing by a physician or optometrist who is appropriately licensed and in good standing. Lenses may be purchased from physicians, optometrists, or optical outlets whose lenses are ground by or under the supervision of an optician certified by the American Board of Optometry.

(Procedure codes 18000-01, 18000-65)

Corrective eyeglasses include spectacle-mounted single element or telescopic low vision aids. DVR does not provide designer frames or frames made out of specialized materials, such as advanced metal alloys. However, high index lenses may be provided for individuals whose distance refraction is greater than or equal to minus 7 (-7).

NOTE: Hand-held low vision aids are considered assistive technology devices and are governed by rates in Chapter 10 of the Fee Schedule.

In addition, DVR does not purchase the following types of lens features unless medically prescribed for a particular visual condition or for specific working conditions related to the individual's chosen vocational goal:

• Contact lenses

• Tinted lenses

• Photochromic lenses

• Scratch resistant lenses

• Lens hardening

(Procedure code 18006-01)

The maximum rate for the repair of eyeglasses is the lowest available usual and customary charge.

DVR has established a structure for allowable fees for the purchase of eyeglasses and contact lenses that is not based on the RVP procedures due to the wide variation of availability and cost across the State. Counselors, however, still should purchase glasses "at the least possible cost," regardless of the maximum fee established in the Fee Schedule and document the need in the service record.

Some vision prescriptions may not fall into one of the routine categories. In such cases, the counselor will use the maximum fees listed as the base rates and have the dispensing optician specify the additional costs required to fill the ophthalmologist’s or optometrist's prescription.

Rates for Corrective Eyeglasses

• Frames - $82.25

• Single Vision - $46.75 per lens

• Bifocal - $70.55 per lens

• Trifocal - $81.20 per lens

*The amounts and lenses below are added to the cost of the glasses if medically prescribed for a particular visual condition or for specific working conditions related to the individual's chosen vocational goal.

• High Index* $55.58 per lens

• Transition*  $51.06 per lens

• Progressive*  $113.85 per Lens

Rates for Contact Lenses

• Standard Hard Lenses  $190.00 per pair

• High RX Lenses $190.00 per pair

• Keratoconic Lenses  $220.00 per pair

• Toric Lenses ( 3 month supply) $1498.98 per pair

• Soft Lenses (3 month supply) $37.50 per pair

The maximum allowable fee for contact lenses is the lower of the rates identified above or the actual billed charge.

(Procedure codes 16500-01, 16500-02, 16500-03, 16500-04, 16500-05, 16500-06, 16500-07, 16500-08, 16500-09, 16500-10)

Payment for ocular prostheses and intraocular lenses provided by the treating physician or the treatment facility follow the procedures outlined in Chapter 1. However, ocular prosthesis provided by a prosthetist are identified by HCPCS codes V2623-2632.

Ocular prosthesis are identified by HCPCS codes, and those listed below may be purchased by DVR. Glass and plastic stock eyes are no longer provided. In addition, glass custom eyes are only prescribed in cases where a previous glass eye is being replaced. Glass custom eyes are not available in the United States and must be purchased from Germany.

HCPCS Codes and Allowable Fees

• V2623 Prosthetic eye, plastic custom $905.68

• V2624 Polishing and resurfacing ocular prosthesis $73.83

• V2626 Enlargement of Ocular Prosthesis $190.23

• V2627 Reduction of ocular prosthesis $1596.47

• V2628 Fabrication/fitting of ocular confirmer $386.80 (Used as initial prosthesis following surgery)

• V2629 Prosthetic eye, other $1,792.43 - $2,581,25 (Used when the injury is more severe and requires special or additional construction to fit the deformity)

• Glass custom eye $826 - $1,032.50

• V2630 Anterior chamber intraocular lens $113.49

• V2631 Iris supported intraocular lens $113.49

• V2632 Posterior chamber intraocular lens $113.49

The maximum allowable fee for an ocular prosthesis is the actual billed charge or the rate identified above, whichever is lower.