Medicare and Aphakic lenses

[Specs]

I just had a patient come in for a pr. of Aphakic SV lenses. Does anybody know the medicare code and re-imbursement amount (at least in your area)for the Ultra-thin lenses, SV? Does this code still exist? The regular codes don't even cover the cost? They're SV poly,ultra thin. Do you bill it as a pr. or -RT, -LT?

[EYERX]

Alan is dat u???
ALAN TRY CODE V2114 sv over +or- 12 diop.pays 68.64 per lens or lenticular non aspheric V2116 pays 54.77 per lens or lenticlar aspheric V2117 pays 64.53 per lens. Bear in mind these are NJ medicare prices the codes will stay the same but the prices vary slightly state to state.
YOUR CHILDHOOD FRIEND
ANDY


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[Bob Rihl]

Originally posted by specs13:
I just had a patient come in for a pr. of Aphakic SV lenses. Does anybody know the medicare code and re-imbursement amount (at least in your area)for the Ultra-thin lenses, SV? Does this code still exist? The regular codes don't even cover the cost? They're SV poly,ultra thin. Do you bill it as a pr. or -RT, -LT?

Alan:
I don't have a computer at the office, just this Webtv at home, so this is second hand from my secretary. Hope I got it right. First of all, we never heard of using an aspheric polycarb on a cataract job, but maybe there's something new we don't know about. The aspheric polycarbs we know about wouldn't normally be used on a +12.00 because they wouldn't have enough "drop" to give adequate periferal vision. So try code V2410, which is "variable asphericity lens, single vision, full field." You will have to fill in RT and LT separately. Also, you'll need to use diagnosis code 379.31 for Aphakia. Not V43.1 for Pseudoaphakia. A lens like a Bristolite 5 drop or a Super Modular or a Perfastar would be the lens normally used on an Aphakic Rx, so I assume Medicare would approve the claim. If you sold them a frame, you have to use V-2020 for "standard frame" (they usually allow about $60.00 and then put the difference between that and what you sold them down under V-2025 (DeLuxe Frame). A $ 150.00 frame isn't exactly what I'd call "DeLuxe", but to Medicare it is. I have no idea what they reimburse for "variable ashericity lenses" since we NEVER accept assignment, but never had any complaints, so they must cover most of what we charge. Also, I think Shannon said you have to put down the dates of surgery and the referring physicians name and ID number. I just sign 'em. I don't look at 'em. I hope whoever thought up Medicare is in Hades, and I'm almost ready for it myself. I think the whole concept is ridiculous.
Old Bob

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