Vision Services Vision Services & & Vision Therapy - PowerPoint PPT Presentation

Vision Services Vision Services & & Vision Therapy Vision Therapy February 2, 2007 February 2, 2007

Who Can Provide Vision Who Can Provide Vision Services? Services? � A licensed ophthalmologist, A licensed ophthalmologist, � optometrist or optician may provide optometrist or optician may provide vision services. vision services.

Covered Covered Vision Services Vision Services � The following services are covered for The following services are covered for � clients under under the age of 21 the age of 21 : : clients – Eye Examinations (92002, 92004, 92012 Eye Examinations (92002, 92004, 92012 – & 92014) & 92014) – Eyeglasses (V2020 Eyeglasses (V2020- -V2499) V2499) – – Contact Lenses (V5200 Contact Lenses (V5200- -V5231) V5231) –

Eye Examinations Eye Examinations (92002, 92004, 92012, 92014) (92002, 92004, 92012, 92014) � Eye exams should determine visual acuity Eye exams should determine visual acuity � and refraction, binocular vision and eye and refraction, binocular vision and eye health. health. – Special ophthalmologic services should be Special ophthalmologic services should be – performed only when medically necessary. performed only when medically necessary. (92015- -92140) 92140) (92015 – Eye care provider records must reflect medical Eye care provider records must reflect medical – necessity and include interpretation and report, necessity and include interpretation and report, as appropriate, of the procedure. as appropriate, of the procedure. � Office exams as medically necessary for the Office exams as medically necessary for the � treatment of eye disease or eye injury. treatment of eye disease or eye injury.

Eyeglasses Eyeglasses (V2020- -V2499) V2499) (V2020 � One pair of eyeglasses is covered One pair of eyeglasses is covered � within a 12- -month period. month period. within a 12 – Replacement of eyeglasses Replacement of eyeglasses – – Repair of eyeglasses Repair of eyeglasses – – Documentation of medically necessity Documentation of medically necessity –

Eyeglasses Cont. Eyeglasses Cont. (V2020- -V2499) V2499) (V2020 – EqualityCare allows up to $76.00 for standard EqualityCare allows up to $76.00 for standard – frames. The provider may not The provider may not “ “balance bill balance bill” ” frames. the client for glasses that cost more than the client for glasses that cost more than the allowable amount unless there is a the allowable amount unless there is a written agreement signed by the client written agreement signed by the client and the provider. and the provider. � For example: When the client selects $120 frames and For example: When the client selects $120 frames and � EqualityCare allows up to $76, then the optometrist EqualityCare allows up to $76, then the optometrist should either mutually agree in writing with the client should either mutually agree in writing with the client that the client is responsible for the additional payment that the client is responsible for the additional payment of the frames ($44) or the provider may bill of the frames ($44) or the provider may bill EqualityCare for $120 and accept the payment of $76 EqualityCare for $120 and accept the payment of $76 as payment in full for the frames. as payment in full for the frames.

Eyeglasses Cont. Eyeglasses Cont. (V2020- -V2499) V2499) (V2020 � Single vision, bifocal or trifocal lenses Single vision, bifocal or trifocal lenses � are covered. are covered. – Miscellaneous services (V2700 Miscellaneous services (V2700- -V2799) are V2799) are – covered only with prior authorization (PA) covered only with prior authorization (PA) and when deemed medically necessary by and when deemed medically necessary by an ophthalmologist or optometrist. an ophthalmologist or optometrist. Exception: V2784 does not require PA Exception: V2784 does not require PA

Eyeglasses Cont. Eyeglasses Cont. (V2020- -V2499) V2499) (V2020 � Polycarbonate lenses (V2784) includes Polycarbonate lenses (V2784) includes � scratch resistant coating and are a covered scratch resistant coating and are a covered service. The procedure code must be billed service. The procedure code must be billed as an add- -on to a standard C on to a standard C- -39 lens. 39 lens. as an add � Reimbursement for dispensing of frames, Reimbursement for dispensing of frames, � frame parts and/or lenses is not allowed in frame parts and/or lenses is not allowed in addition to reimbursement for dispensing of addition to reimbursement for dispensing of total eyeglasses. total eyeglasses. � Providers must use the order date as the Providers must use the order date as the � date of dispensing. date of dispensing.

Contact Lenses Contact Lenses (V5200- -V5231) V5231) (V5200 � Contact lenses are covered for correction of Contact lenses are covered for correction of � pathological conditions when useful vision pathological conditions when useful vision cannot be obtained with regular lenses. cannot be obtained with regular lenses. � Prior authorization is not required at the Prior authorization is not required at the � time of service; however, the medical record time of service; however, the medical record should document the client’ ’s need for s need for should document the client contact lenses versus eyeglasses. contact lenses versus eyeglasses.

Covered Services Covered Services � The following services are covered for The following services are covered for � clients over over the age of 21 the age of 21 : : clients – Eye Examinations (92002, 92004, 92012 & Eye Examinations (92002, 92004, 92012 & – 92014) 92014) – Treatment of eye disease or eye injury. Treatment of eye disease or eye injury. – – Payment of deductible and/or coinsurance due Payment of deductible and/or coinsurance due – on Medicare crossover claims for post surgical on Medicare crossover claims for post surgical contact lenses and/or eyeglasses. contact lenses and/or eyeglasses.

Vision Therapy Vision Therapy (92065) (92065) � Vision therapy is a sequence of activities Vision therapy is a sequence of activities � individually prescribed and monitored by the individually prescribed and monitored by the doctor to develop efficient visual skills and doctor to develop efficient visual skills and processing. processing. � Research has demonstrated vision therapy Research has demonstrated vision therapy � can be an effective treatment option for can be an effective treatment option for individuals under the age of 21 or individuals under the age of 21 or individuals with Acquired Brain Injury (ABI). individuals with Acquired Brain Injury (ABI).

Vision Therapy Vision Therapy (92065) (92065) � Vision therapy is administered in the Vision therapy is administered in the � office under the guidance of a office under the guidance of a practitioner and requires a number of practitioner and requires a number of office visits depending on the severity office visits depending on the severity of the diagnosis conditions. of the diagnosis conditions.

Vision Therapy Vision Therapy (92065) (92065) � Research has demonstrated vision therapy can be an Research has demonstrated vision therapy can be an � effective treatment option for: effective treatment option for: – Ocular motility dysfunctions (eye movement disorders) Ocular motility dysfunctions (eye movement disorders) – – Non Non- -strabismic strabismic binocular disorders (inefficient eye binocular disorders (inefficient eye – teaming) teaming) – Strabismus (misalignment of the eyes) Strabismus (misalignment of the eyes) – – Amblyopia (poorly developing vision) Amblyopia (poorly developing vision) – – Accommodative disorders (focusing problems) Accommodative disorders (focusing problems) – – Visual information processing disorders, including visual Visual information processing disorders, including visual- - – motor integration and integration with other sensory motor integration and integration with other sensory modalities. modalities. Prior authorization is not required. Prior authorization is not required.

Training Aids Training Aids (99070) (99070) � Vision therapy training aids will be Vision therapy training aids will be � reimbursed at cost of invoice. Please reimbursed at cost of invoice. Please submit invoice with statement of submit invoice with statement of medical necessity using CPT code medical necessity using CPT code 99070. 99070.

Vision Therapy Vision Therapy Coding for clients under under the age of 21: the age of 21: Coding for clients � Vision therapy visits are capped at 32 per Vision therapy visits are capped at 32 per � 365 days for treatment of ICD- -9 diagnosis. 9 diagnosis. 365 days for treatment of ICD � Additional visits or exceptions to these Additional visits or exceptions to these � diagnosis codes will be considered on a diagnosis codes will be considered on a case- -by by- -case basis only. case basis only. case � In addition to the referenced ICD In addition to the referenced ICD- -9 codes, 9 codes, � vision therapy services performed in- -office office vision therapy services performed in are reported with CPT code 92065. are reported with CPT code 92065.