The following instructions should be used for submitting services for Hydrophilic Contact Lenses:
HCPCS Codes:
- V2521 - toric or prism ballast, per lens
- V2522 - bifocal, per lens
- V2523 - extended wear, per lens
Documentation Requirements:
HCPCS codes V2521 through V2523 require an invoice when submitted. If an invoice is not submitted, the service will be rejected. Rejected claims must be resubmitted as new claims.
National Coverage Determination:
Hydrophilic contact lenses are not covered when used in the treatment of nondiseased eyes with spherical ametrophia, refractive astigmatism, and/or corneal astigmatism. Payment may be made under the prosthetic device benefit, however, for hydrophilic contact lenses when prescribed for an aphakic patient.
Hydrophilic Contact Lens for Corneal Bandage:
Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bulbous keratopathy, dry eyes, corneal ulcers and erosion, keratitis, corneal edema, descemetocele, corneal ectasis, Mooren's ulcer, anterior corneal dystrophy, neurotrophic keratoconjunctivitis, and for other therapeutic reasons. Payment for the lens is included in the payment for the physician's service to which the lens is incident.
Reference:
Jurisdiction:
- When the above services are provided incident to a physician's service, submit claims to Palmetto GBA
- In all other situations, the services should be submitted to the DME MAC