Refractive Lenses - JA DME
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist Refractive Lenses [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Refractive Lenses Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
|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
|Standard vs. Deluxe Frames
|The difference between standard and deluxe frames isn’t determined by the cost of the frames.
|Billing for Deluxe Frame
|When billing for deluxe frames two HCPCS codes on two claim lines will be billed, utilizing the upgrade billing.
|Progressive Lenses Billing Guidelines
|When billing a claim for progressive lenses, claim line order: