Therapeutic Lens Billing?

[kdw613]

I am a Licensed Optician (In Ohio) who offers Migraine relief lenses to patients. I have billed a few through State Medicaid programs successfully, as I am a Medicaid provider. I have never billed non-Medicaid plans and I'm wondering if the process is similar. I am curious if anyone has any experience billing for tints/treatments (with proper diagnosis codes) through various insurance companies.
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[drk]

How much can a tint cost, anyway?

[SergeTrigger]

I know VSP covers Pink/Rose 1 or 2 tints.
Per the VSP manual:

Patients are covered for all plastic Pink I and II solid dyes, which can be ordered under a variety of names including Cruxite A, Cruxite AX, Softlite A, Softlite B, Rose I, Rose II, Flesh, Blush, Nutratint Pink, and Lite Pearl.

So, if you're treatment is a tint that falls under that category and your VSP lab can do it you would just order like normal through VSP and choose "other" for the tint color then put what color/treatment you want in the notes. If you do the tint in office, I think you can specify that as well.

If it's a non-tint treatment I'm not sure. I know VSP specifically lists "neurolens" as a lens type they don't pay for and I have a feeling that might apply to most "therapeutic" lens designs.

[NAICITPO]

The only thing VSP will pay for is just the standard tint fee. I would suggest not even billing this to VSP and having an out of pocket schedule for things like FL41 lenses. I tried billing one to VSP and we definitely came out on the losing end of that.

IF they had a tint sample I could send to the lab and I could ask the lab to match it that would be one thing. However, if they are asking for a very specific therapeutic tint where the lenses need to be checked to make sure they are blocking light at a certain wave length that is something I would tell them that is not covered by vision insurance. Because the lab is certainly going to charge you more for it than a standard tint fee, you should not just charge the $15 bucks the VSP formulary says to for this service.

I would imagine Eyemed and all of the other MVCs are the same way, if they can avoid paying extra for things they will.