CPT code to get paid for adjusting/fixing glasses for medicaid patients?!

**EYESPLC** · 10-23-2014, 01:13 PM

I signed up for this forum because just in searching the internet for answers to some of my optical questions, it seemed that most of my answers were populating from this forum. I was very intrigued by the amount of people on here and all the resourceful information!! So with that said, I am a newby here, and I thought I would take a stab at posting my first question that I can't seem to find an answer for anywhere else. I recently had a rep stop in our office ( a medicaid lab rep) and informed me about a CPT code that you can use for fixing/adjusting a pair of medicaid glasses. ( The code is 92370) I was a little dumbfounded that I had not heard of this prior to him to telling me, but I tried billing it, and he was right! I did get denied because he told me to use a routine diagnoses code ( I used their 367.4 that I used for their glasses) and it said the diagnoses was invalid. BUT it did show the allowed amount that it would of paid if the diagnoses was correct. So my question is, has anyone else been billing this CPT code, and if you have, what diagnoses code should you use with it?

**becc971** · 10-23-2014, 02:04 PM

routine would be V72.0 I believe, I did not know about this nifty trick though!! learn something new every day :) what state do you bill in? I wonder if it works here in maine.

welcome ... don't get scared away

**EYESPLC** · 10-23-2014, 02:17 PM

I am from the good 'ol mitt...Michigan.

From what it sounded like to me, it was an HMO medicaid thing, that they would pay that code. (We bill Health Plus and McLaren Medicaid) I didn't think to bill the V72.0, but I am wondering if it will still deny it...does it need a more specific code for it to be paid? Can't find any more information on it as far as billing goes, so I guess it wouldn't hurt to try billing the V72.0 and see what I get!

Thanks for the welcome...really have enjoyed all the discussions!

**chaoticneutral** · 10-23-2014, 02:28 PM

We use 92370 with v72.0 and get paid every time. The toughest part is reminding opticians to use it. It worked out just fine in FL and NH.

**Uilleann** · 10-23-2014, 04:09 PM

That code doesn't have a fee attached to it on the CMS national site. At least not for Utah here. Would it vary from state to state based on their Medicaid (only) programs instead? If I'm reading this right, that's how it seems to appear...

**EYESPLC** · 10-24-2014, 08:21 AM

Originally Posted by Uilleann

That code doesn't have a fee attached to it on the CMS national site. At least not for Utah here. Would it vary from state to state based on their Medicaid (only) programs instead? If I'm reading this right, that's how it seems to appear...

The fee we use here is $20. The allowable amount that shows for that service is $17.62. That amount I know is correct because it even though I got denied, it did still show the allowable amount of the $17.62 on the claim. Whether it varies from state to state, that I am not sure of! I haven't been able to find much on the topic, so that's why I was hoping someone on here had more experience with it! Hope that little bit of extra info helps!!!

**Uilleann** · 10-24-2014, 11:21 AM

It does thanks. As Medicaid plans can vary wildly even in state, I expect even more variation from one state to another. In all the digging I managed yesterday, I wasn't able to find anywhere that showed it as a payable code here in Utah. Billable - yes. Just not payable. Hope it ends up working out in your favor there.