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Thread: Medicaid Billing for Materials

  1. #1
    OptiBoard Novice
    Join Date
    Jul 2020
    Dispensing Optician

    Medicaid Billing for Materials

    Hey all -

    I am considering trying to expand our Medicaid coverage from exam only to DME (Durable Medical Equipment... aka glasses and contact lenses). It's been a few years since I worked at an office that billed for specifically routine exam and eyeglasses. I think I have a handle on the glasses (bill for poly, aspheric, dispensing fee/adjustments, keep all on single HICF, inexpensive frame, patient pays for other upgrades-photochromic/AR, only bill for 1 pair per day). But while I was reviewing CPT codes and I am seeing decent payments for Exam (92004/92014) and believe it or not a CL Exam code (92310) for over $100.00 per my states payment schedule. I also see payment schedule for the contact lenses too (V2520 / V2521).

    I would like to pick the brain of anyone currently taking and filing claims for glasses and Ideally Contact Lenses. I want to know if it does work without need any prior approval or any other hoops we need to jump through without causing too much brain damage.

    If I am incorrect on my understand of billing glasses, or missed something important please let me know as well!

    Thank you all!
    - Mindy

  2. #2
    OptiBoard Professional Excel-Lentes's Avatar
    Join Date
    Oct 2001
    Hartford, CT
    Dispensing Optician

    Each state administers its own medicaid program. You would need to consult with the CO medicaid program directly for those details. From what I read some states use Eyemed and some use the prison system to fabricate eyewear and the optician receives a small dispensing fee. Where I live contacts are medically necessary only. The reimbursement is not sustainable for the contacts materials. We currently process all the eyewear and select which frames to offer so we can largely control costs, quality and service.

    ~Peace and health

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