Transition Lenses

[Tammy]

I need help, when billing for DME equiptment, post cataract glasses, and a patient orders transition lenses, I have always billed V2799 (a noc code) with a GA modifier for that specific material, I have always included a narrative on line 19 referring to that code stating it is a transition lens, I do not bill V2744 due to the fact that the allowed amount is only $13.49 per lens, and it does not even cover cost, I use that code for PGX (glass only lenses). I know many of you are saying why bill it at all, but per Medicare I must bill for every item the patient orders, regardless of coverage, that is why I use a GA modifier (that means that the patient has been informed that this particular item is not covered and they are responsible, and they sign a waiver to that effect.) Just recently I have been rejected stating that they need documentation as to what Transitions are. I have gone into the web site and they have a consumers description, I want the technical description, and have put a call into them.

What my question is.......How do you bill for these Not Otherwise Classified codes? Do you bill Transitions as a V2799 or a V2744 and why?

Your input will be greatly appreciated.

Tammy
your friend in the billing department

[Bev Heishman]

We use V2744. Photochromics are not covered by DMERC. We bill but it is not paid. The patient pays the amount becuse it is an uncovered service. They sign in advance. Not all glass photochromics fall under the allowance price either listed by DMERC especially PBX, T&D or PGX dependending on lens style.