Coding & Reimbursement
Billing for Bandage Contact Lenses
Confused about when to seek reimbursement? Here's the information you need.

As you know, Medi-care won't separately reimburse contact lenses that you prescribe to correct refractive error (except for aphakic and pseudo-phakic patients), and other third-party payers only offer limited coverage. However, Medicare does cover bandage contact lenses (BCL) that are used for therapeutic purposes -- e.g., to promote healing or for pain management.

During the year 2000, Medicare paid about 18,000 claims for BCLs out of a universe of approximately 24 million eye exams. I suspect that billing for bandage contact lenses is under-used because of confusion about coverage and billing requirements.

Q: How should I bill for a bandage contact lens? The CPT code for this is 92070 (Fitting of contact lens for treatment of disease, including supply of lens). Note that "lens" is singular; Medicare's physician fee schedule defines this service as unilateral and indicates that it reimburses 100% of the allowed amount for each eye.

When you submit a claim, use modifier -RT, -LT or -50 (both eyes) where applicable. The 2003 national Medicare unadjusted allowable fee for 92070 is $61.41.

Q: When does Medicare cover use of a bandage lens? Here's how Medicare's National Coverage Determinations (NCD) describes covered uses of BCLs: "Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bullous keratopathy, dry eyes, corneal ulcers and erosion, keratitis, corneal edema, desce-metocele, corneal ectasis, Mooren's ulcer, anterior corneal dystrophy, neurotrophic keratoconjunctivitis and for other therapeutic reasons."

Q: When does Medicare not cover a bandage lens? Exceptions to coverage include:

Corneal collagen shields. The term "hydrophilic contact lens" doesn't include corneal collagen shields; in fact, several Medicare policies specifically preclude coverage of collagen lenses.

Excessive frequency of use. If you bill for 92070 more than once a month per patient, Medicare may deny your claim. In this case, get the patient's signature on an Advanced Beneficiary Notice (ABN) indicating that the patient accepts financial responsibility in the event of a denial, before dispensing the BCL. (The ABN must include a brief description of the BCL and the reason you expect a denial, i.e., "Medicare doesn't cover more than one replacement lens per month." Simply stating that Medicare won't pay isn't sufficient.)

Following surgery. Some-times a BCL is applied in the operating room. The facility fee of the ASC or hospital includes this, so you shouldn't charge 92070 as an adjunct to the surgical procedure.

Also, BCLs dispensed in the office to aid in post-surgery recovery are not separately billed or reimbursed. These are included in Medicare's global surgery fee. (MCM §4821.A says that "all additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room" are included in the global fee.)

When bundled with an eye exam. Some Medicare carriers (but not all) won't reimburse separately for 92070 if an eye exam is billed at the same time.

Q: Can I ever bill separately for the lenses themselves? In this context, the service (92070) in-cludes the materials. For that reason, it's not appropriate to make a separate claim for the BCL supply using V25xx (contact lens) or 9239x (supply of materials).

Suzanne Corcoran is vice president of Corcoran Consulting Group. You can reach her at (800) 399-6565 or at scorcoran@corcoranccg.com.