All eye examination fees cover both eyes unless otherwise indicated.
Do not bill professional or technical fee separately to the Plan: for institutional information only.
Payable for post-operative corneal transplant assessment, maximum six per year per patient. In cases of problematic corneal transplant or unresolved astigmatism, additional tests may be paid, if accompanied by the following code (9968).
This fee includes both eyes, whether at one time or two separate visits.
iii) Payable for corneal thinning disorders, including keratoconus and pellucid marginal degeneration, where progressive astigmatic change greater than 1 diopter in a year has been documented, corneal epithelial or stromal scarring, where the visual central axis of the cornea is affected. Payable once per year per patient. In cases where there is documented progression of any of these conditions, additional tests may be paid, if accompanied by the following code (V80).
iv) Not payable for pre- or post-operative cataract patients except where there is documented evidence of irregular astigmatism resulting from the cataract surgery.
v) Payable with following fee items if medically necessary: 02015, 02018, 02019, 22169, 02010 and 02012.
vi) Note record or letter must be submitted to document evidence of results derived from CCT when billing eye exams.
vii) Keratometry (02038) not payable in addition.
viii) Not an insured benefit when used in association with laser refractive surgery or assessment for same.