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
|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.
|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:
Last Updated Fri, 28 Jan 2022 14:34:18 +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.