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!