Hydrophilic Contact Lenses: Require Invoice
The following instructions should be used for submitting services for Hydrophilic Contact Lenses:
- V2521 — toric or prism ballast, per lens
- V2522 — bifocal, per lens
- V2523 — extended wear, per lens
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 Determinations (NCDs):
Hydrophilic Contact Lens (for other than Corneal Bandage) – NCD 80.4
Hydrophilic contact lenses are not covered when used in the treatment of nondiseased eyes with spherical ametrophia, refractive astigmatism and/or corneal astigmatism. Payment made be made under the “prosthetic” device benefit when prescribed for an aphakic patient, however, the claim should be submitted to the DMAC (Durable Medical Administrative Contractor).
Hydrophilic Contact Lens for Corneal Bandage – NCD 80.1
Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology (i.e., 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.
- CMS National Coverage Determinations Manual (PDF, 679 KB) (Pub. 100-03), Chapter 1, Sections 80.1 and 80.4
- 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