Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Optometric/Optical Services)
Ophthalmological
Services
Charges for Lenses and
Contact Lens Fitting
Eyewear billing and
Reimbursement
11-2
Blue Cross coding policy follows the CPT system of descriptive
terms and identifying codes for reporting medical services and
procedures performed by physicians and optometrists.
Both E/M codes and ophthalmology codes 92002, 92004, 92012,
92014, and 92015, may be appropriate to use by optometrists or
ophthalmologists. The level of E/M service or the selection of
ophthalmology codes must appropriately reflect the medical
condition, the medical necessity, the tests performed, and be
documented in the patient record. Selection of either an E/M code
or an ophthalmology code may be appropriate for routine or
medical diagnoses, and should be based on the CPT definitions of
services provided. Details of the patient encounter, as recorded on
the patient record, must meet or exceed the stated CPT
requirements to qualify for the code selected.
Blue Cross requires that all medical services be performed by the
professionals eligible and credentialed to perform the service. The
diagnosis and CPT coding must appropriately reflect the medical
condition and that the medical record reflect the medical necessity
and severity of the condition.
Submit charges for any type of lenses using Level II HCPCS
codes. Any fee for fitting and prescription of contact lenses may be
reported by submitting a CPT code from the contact lens services
section in addition to the contact lens supply code. The fee for
fitting and prescription of contact lenses may also be included in
the contact lens charge.
Eyewear claims will be paid to the member, not the provider. This
affects all of our members with the exception of Prepaid Medical
Assistance Program (PMAP) or Minnesota Care (MNCARE)
coverage.
If you bill eyewear for a member, you should bill the eyewear on a
separate claim form from the one used for the eye exam. Use your
optician’s contracting provider number or NPI when billing for the
eyewear. Your optometrist’s contracting provider number or NPI
should be submitted when billing for the eye exam. Blue Cross
requires that eye exams and eyewear claims not be billed on the
same claim form.
Routine Vision Services Blue Plus contracts allow routine vision exams without a referral.
However, if an illness or problem is discovered, treatment requires
a referral from the patient’s primary care clinic.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (11/15/10)