What has changed?
On July 1, 2021, the Health Care Authority (HCA) made updates to the ProviderOne billing system to direct claims for vision hardware fitting fees and some prescription fees for clients enrolled in a managed care organization (MCO) to the client’s MCO for payment. These fees were previously covered under fee-for-service (FFS).
Retroactive for claims with dates of service on and after July 1, 2021, all medical providers must bill these codes directly to the MCOs.
CPT® codes affected by this change:
- 92071 Contact lens fitting for TX
- 92072 Fit contact lens for managment
- 92310 Contact lens fitting
- 92311 Contact lens fitting
- 92312 Contact lens fitting
- 92313 Contact lens fitting
- 92340 Fit spectacles monofocal
- 92341 Fit spectacles bifocal
- 92342 Fit spectacles multifocal
- 92352 Fit aphakia spectcl monofocl
- 92353 Fit aphakia spectcl multifoc
- 92354 Fit spectacles single system
- 92355 Fit spectacles compound lens
What has not changed?
The prescription CPT® codes and repair CPT® codes listed below should continue to be billed to HCA through FFS, not through the client’s MCO. HCA will reprocess claims with dates of service on and after July 1, 2021, that were denied for these CPT® codes.
- 92314 Prescription of contact lens
- 92315 Rx cntact lens aphakia 1 eye
- 92316 Rx cntact lens aphakia 2 eye
- 92317 Rx corneoscleral contact lens
- 92370 Repair & adjust spectacles
- 92371 Repair & adjust spectacles
HCA will notify providers of any future changes through Provider Alerts and the billing guides for Physician-Related Services/Health Care Professional Services and Vision Hardware for Clients 20 Years of Age and Younger.
CPT® codes and descriptions only are copyright 2020 American Medical Association.