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Refractive Lenses - JA DME

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Refractive Lenses

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RT/LT Modifiers 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.
  • 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.
Billing for Deluxe Frame 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.
Progressive Lenses Billing Guidelines 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

 

Last Updated Wed, 12 Oct 2022 16:36:54 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

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