Refractive Lenses - JA DME

Effective for claims with dates of service (DOS) on/after 3/1/2019, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 UOS on each claim line. Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding. See Correct Coding - RT and LT Modifier Usage Change for more information.

The difference between standard and deluxe frames isn't determined by the cost of the frames.

• Standard frame is a very basic frame,
  • Covered by Medicare
• Deluxe frame is one with additional features
  • E.g., spring hinges or memory metal construction – something outside of the normal frame composition
  • Not covered by Medicare

To determine which are considered standard and which are considered deluxe frames, please refer to the Pricing, Data Analysis, and coding (PDAC) website.

When billing for deluxe frames two HCPCS codes on two claim lines will be billed, utilizing the upgrade billing.

• First claim line: V2020 for standard frame with the appropriate modifiers
  • KX and GK will be appended to the qualifying V2020
  • Usual and customary fee
• Second claim line: V2025 for deluxe frame code
  • No modifiers required
  • Difference between usual and customary fee for deluxe frame and usual and customary fee of standard frame
• This information is found in the Refractive Lenses LCD L33793 and Policy Article A52499.

When billing for deluxe frames, an ABN is not required since the deluxe frames deny noncovered as beneficiary responsibility, however a voluntary ABN may be obtained so the beneficiary is aware of the financial obligation.

When billing a claim for progressive lenses, claim line order:

• First two lines of claim
  • Standard bi-focal (V2200-V2299) RT and LT modifiers on separate lines or
  • Tri-focal (V2300-V2399) RT and LT modifiers on separate lines
• Next two lines V2781 for progressive lenses