OptumHealth Vision (Spectera) Modifier Codes

OptumHealth Vision (Spectera)
Modifier Codes
In this document:
• Mapping Contact Lens Modifier Codes, 1
• OptumHealth Vision Contact Lens Modifier Codes, 3
As of July 1, OptumHealth Vision (Spectera) will require that all contact lens
claims be submitted with contact lens modifier codes. This document tells you
how to update your AcuityLogic system so that modifier codes are added to
contact lens claims for OptumHealth Vision.
If you use AcuityLogic On Premises, follow the instructions in this document to
map your OptumHealth Vision formulary lenses to the appropriate contact lens
modifiers.
If you use AcuityLogic On Demand, your AcuityLogic system has been updated
so that all OptumHealth Vision formulary lenses are mapped to the appropriate
contact lens modifiers.
After contact lenses are mapped to their corresponding modifier codes, the
correct modifier codes will be automatically added to claims when billing
OptumHealth Vision for contact lenses.
If needed, contact OptumHealth Vision for a complete list of modifier codes or a
billing guide.
NOTE
This document was last updated on June 25, 2012. This document is
subject to change at any time without notice.
Mapping
Contact Lens
Modifier
Codes
This section tells you how to map covered disposable contact lenses and monthly
planned replacement contact lenses. You do not need to map non-covered
contact lenses, as these will be mapped for you.
1. Review the table “OptumHealth Vision Contact Lens Modifier Codes” on
page 4 to determine which contact lenses need to be mapped to which
modifier codes.
2. From AcuityLogic Admin, click Product, select Contact Lens, and select
Contact Lens.
The Contact Lens window opens.
3. Search for a contact lens that you want to map.
®
OptumHealth Vision (Spectera) Modifier Codes 1

OptumHealth Vision (Spectera) Modifier Codes
Mapping Contact Lens Modifier Codes
4. Click the Mapping Partners hyperlink in the row of the contact lens you want
to map.
The Partner Mapping window for that contact lens opens.
5. Click the Edit hyperlink in the Spectera Modifier Codes row, type the
two-letter OptumHealth Vision contact lens modifier code in the Code 1 text
box, and click Update.
NOTE
For a list of modifier codes, refer to the table “OptumHealth
Vision Contact Lens Modifier Codes” on page 4.
6. Click Return to close the window.
7. Repeat steps 2–6 for each contact lens on the OptumHealth Vision
formulary.
2 OptumHealth Vision (Spectera) Modifier Codes

OptumHealth Vision (Spectera) Modifier Codes
OptumHealth Vision Contact Lens Modifier Codes
Optum-
Health Vision
Contact Lens
Modifier
Codes
The table below lists all contact lenses in the OptumHealth Vision (Spectera)
formulary and their corresponding modifier codes:
Contact Lens
Ciba DAILIES AquaComfort Plus® 30 pack
Modifier Code
CD
Ciba Focus® DAILIES® Toric ADC 30 pack
Ciba Focus® DAILIES® Progressives 30 pack
CooperVision Proclear® 1 day 30 pack
2Clear I Day 30 pack
EasyWear 1 Day 30 pack
Johnson & Johnson 1 Day Acuvue® Moist® 30 pack
Bausch & Lomb® Soflens® 38
CIBA Vision Freshlook® Handling Tint
CooperVision Avaira®
Aquaclear 100
Aquatech Plus
EasyWear 100
Sofmed Breathables
CooperVision Biomedics® XC
2Clear XC
CooperVision Biomedics® 55 Premier
Sofmed 55
Johnson & Johnson ACUVUE® ADVANCE® Plus
Johnson & Johnson ACUVUE®
Johnson & Johnson ACUVUE® 2
Johnson & Johnson ACUVUE® OASYS® with
HYDRACLEAR® Plus
CIBA Vision AIR OPTIX® AQUA
CooperVision Biofinity®
Aquaclear
CooperVision Frequency® 55 Aspheric
Provision Premium Aspheric
2Clear Premium
CooperVision Frequency® 55
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CD
CM
CM
CM
CM
CM
CM
CM
OptumHealth Vision (Spectera) Modifier Codes 3

OptumHealth Vision (Spectera) Modifier Codes
OptumHealth Vision Contact Lens Modifier Codes
Contact Lens
2Clear
Provision 55 Sphere
CooperVision Proclear®
Modifier Code
CM
CM
CM
Table 1-1:
OptumHealth Vision Contact Lens Modifier Codes
4 OptumHealth Vision (Spectera) Modifier Codes