Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 315.00 - Rates for Vision Care Services and Ophthalmic Materials
Section 315.04 - Allowable Fees for Vision-care Services

Procedure Code

Rate

Description

76512

$100.44

Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan)

76513

$100.44

Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy, unilateral or bilateral

76514

$9.31

Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)

92002

$56.38

Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient

92004

$72.97

Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits

92012

$47.22

Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient

92014

$53.65

Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits

92015

$13.42

Determination of refractive state

92020

$21.50

Gonioscopy (separate procedure)

92065

$29.35

Orthoptic training

92081

$22.69

Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent)

92082

$59.74

Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (e.g., at least two isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)

92083

$87.78

Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (e.g., Goldmann visual fields with at least three isopters plotted and static determination within the central 30 degrees or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2)

92100

$32.20

Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure)

92225

$49.71

Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; initial

92226

$45.07

Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; subsequent

92229

I.C.

Imaging of retina for detection or monitoring of disease; point-of-care automated analysis and report, unilateral or bilateral

92230

$76.75

Fluorescein angioscopy with interpretation and report

92260

$27.20

Ophthalmodynamometry

92275

$95.32

Electroretinography with interpretation and report

92285

$40.20

External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography)

92310

I.C.

Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia

92326

$51.02

Replacement of contact lens

92340

$30.24

Fitting of spectacles, except for aphakia; monofocal

92340 RB

$9.30

Fitting of spectacles, except for aphakia; monofocal (replacement and repair) (per lens)

92341

$37.32

Fitting of spectacles, except for aphakia; bifocal

92341 RB

$13.92

Fitting of spectacles, except for aphakia; bifocal (replacement and repair) (per lens)

92342

$37.32

Fitting of spectacles, except for aphakia; multifocal, other than bifocal

92342 RB

$13.92

Fitting of spectacles, except for aphakia; multifocal, other than bifocal (replacement and repair) (per lens)

92370

$11.76

Repair and refitting spectacles; except for aphakia

92499

I.C.

Unlisted ophthalmological service or procedure

92541

$46.03

Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording

92542

$40.42

Positional nystagmus test, minimum of four positions, with recording

92544

$31.29

Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording

99173

$23.65

Screening test of visual acuity, quantitative, bilateral

99202

$52.59

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.

99203

$78.42

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.

99204

$111.17

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.

99205

$140.85

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.

99211

$17.03

Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional

99212

$31.36

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, ten-19 minutes of total time is spent on the date of the encounter.

99213

$43.34

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.

99214

$67.85

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.

99215

$98.76

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.

99241

$38.62

Office consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.

99242

$59.65

Office consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.

99243

$76.99

Office consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.

99244

$107.34

Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.

99245

$145.17

Office consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family.

99251

$38.20

Inpatient consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 20 minutes are spent at the bedside and on the patient's hospital floor or unit.

99252

$61.88

Inpatient consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 40 minutes are spent at the bedside and on the patient's hospital floor or unit.

99253

$91.80

Inpatient consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 55 minutes are spent at the bedside and on the patient's hospital floor or unit.

99254

$132.27

Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent at the bedside and on the patient's hospital floor or unit.

99304

$49.95

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.

99305

$66.76

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.

99306

$85.15

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient's facility floor or unit.

99307

$27.53

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, ten minutes are spent at the bedside and on the patient's facility floor or unit.

99308

$43.13

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit.

99309

$59.40

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.

99310

$59.40

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.

99328

$71.15

Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver.

99337

$49.64

Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver.

99341

$45.98

Home visit for the evaluation and management of a new patient, which requires these three key components: A problem focused history; A problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.

99342

$67.45

Home visit for the evaluation and management of a new patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.

99343

$97.70

Home visit for the evaluation and management of a new patient, which requires these three key components: A detailed history; A detailed examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.

99344

I.C.

Home visit for the evaluation and management of a new patient, which requires these three key components: A comprehensive history; A comprehensive examination; and medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.

99347

$35.88

Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making; Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.

99348

$56.41

Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.

99349

$86.60

Home visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.

T2002

$9.73

Nonemergency transportation; per diem

Procedure Code

Rate

Description

V2020

$58.74

Frames, purchases

V2025

I.C.

Deluxe frame

Procedure Code

Rate

Description

V2100

$32.47

Sphere, single vision, plano to plus or minus 4.00, per lens

V2101

$34.23

Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens

V2102

$48.14

Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens

V2103

$28.22

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens

V2104

$31.22

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

V2105

$34.01

Spherocylinder, single vision, plano to plus orminus 4.00d sphere, 4.25 to 6.00d cylinder, per lens

V2106

$40.53

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens

V2107

$35.87

Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, 0.12 to 2.00dcylinder, per lens

V2108

$37.14

Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens

V2109

$41.14

Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

V2110

$41.35

Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens

V2111

$42.30

Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 0.25 to 2.25d cylinder, per lens

V2112

$46.17

Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens

V2113

$53.35

Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens

V2114

$56.35

Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens

V2115

$61.35

Lenticular (myodisc), per lens, single vision

V2118

$81.07

Aniseikonic lens, single vision

V2121

$70.09

Lenticular lens, per lens, single

V2199

I.C.

Not otherwise classified, single vision lens

Procedure Code

Rate

Description

V2200

$45.85

Sphere, bifocal, plano to plus or minus 4.00d, per lens

V2201

$49.02

Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens

V2202

$55.90

Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens

V2203

$45.54

Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens

V2204

$48.07

Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

V2205

$51.12

Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens

V2206

$53.32

Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens

V2207

$51.69

Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 0.12 to 2.00d cylinder, per lens

V2208

$52.69

Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens

V2209

$59.67

Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

V2210

$59.74

Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens

V2211

$66.98

Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 0.25 to 2.25d cylinder, per lens

V2212

$72.87

Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens

V2213

$70.22

Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens

V2214

$69.43

Spherocylinder, bifocal, sphere over plus or minus 12.00d, per lens

V2215

70.48

Lenticular (myodisc), per lens, bifocal

V2218

$111.82

Aniseikonic, per lens, bifocal

V2219

$36.92

Bifocal seg width over 28 mm

V2220

$29.93

Bifocal add over 3.25d

V2221

$87.30

Lenticular lens, per lens, bifocal

V2299

I.C.

Specialty bifocal (by report)

Procedure Code

Rate

Description

V2300

$59.98

Sphere, trifocal, plano to plus or minus 4.00d, per lens

V2301

$81.52

Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d per lens

V2302

$90.66

Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00, per lens

V2303

$60.45

Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens

V2304

$62.03

Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 2.25 to 4.00d cylinder, per lens

V2305

$77.30

Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens

V2306

$74.82

Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens

V2307

$81.46

Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 0.12 to 2.00d cylinder, per lens

V2308

$83.90

Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens

V2309

$95.82

Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

V2310

$81.12

Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens

V2311

$93.16

Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 0.25 to 2.25d cylinder, per lens

V2312

$99.05

Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens

V2313

$107.95

Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens

V2314

$89.13

Spherocylinder, trifocal, sphere over plus or minus 12.00d, per lens

V2315

$131.92

Lenticular, (myodisc), per lens, trifocal

V2318

$162.19

Aniseikonic lens, trifocal

V2319

$44.12

Trifocal seg width over 28 mm

V2320

$43.43

Trifocal add over 3.25d

V2321

$128.81

Lenticular lens, per lens, trifocal

V2399

I.C.

Specialty trifocal (by report)

Procedure Code

Rate

Description

V2410

$74.34

Variable asphericity lens, single vision, full field, glass or plastic, per lens

V2430

$91.37

Variable asphericity lens, bifocal, full field, glass or plastic, per lens

V2499

I.C.

Variable sphericity lens, other type

Procedure Code

Rate

Description

V2500

$70.67

Contact lens, PMMA, spherical, per lens

V2501

$136.89

Contact lens, PMMA, toric or prism ballast, per lens

V2502

$166.01

Contact lens PMMA, bifocal, per lens

V2503

$155.31

Contact lens, PMMA, color vision deficiency, per lens

V2510

$105.02

Contact lens, gas permeable, spherical, per lens

V2511

$176.28

Contact lens, gas permeable, toric, prism ballast, per lens

V2512

$184.70

Contact lens, gas permeable, bifocal, per lens

V2513

$149.65

Contact lens, gas permeable, extended wear, per lens

V2520

$49.46

Contact lens, hydrophilic, spherical, per lens

V2521

$75.96

Contact lens, hydrophilic, toric, or prism ballast, per lens

V2522

$93.26

Contact lens, hydrophilic, bifocal, per lens

V2523

$78.38

Contact lens, hydrophilic, extended wear, per lens

V2530

I.C.

Contact lens, scleral, gas impermeable, per lens (for contact lens modification, see 92325)

V2531

I.C.

Contact lens, scleral, gas permeable, per lens (for contact lens modification, see 92325)

V2599

I.C.

Contact lens, other type

Procedure Code

Rate

Description

V2600

I.C.

Hand held low vision aids and other nonspectacle mounted aids

V2610

I.C.

Single lens spectacle mounted low vision aids

V2615

I.C.

Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system

Procedure Code

Rate

Description

V2623

I.C.

Prosthetic eye, plastic, custom

V2624

I.C.

Polishing/resurfacing of ocular prosthesis

V2625

I.C.

Enlargement of ocular prosthesis

V2626

I.C.

Reduction of ocular prosthesis

V2627

I.C.

Scleral cover shell

V2628

I.C.

Fabrication and fitting of ocular conformer

V2629

I.C.

Prosthetic eye, other type

Procedure Code

Rate

Description

V2630

I.C.

Anterior chamber intraocular lens

V2631

I.C.

Iris supported intraocular lens

V2632

I.C.

Posterior chamber intraocular lens

Procedure Code

Rate

Description

V2700

$38.07

Balance lens, per lens

V2710

$53.15

Slab off prism, glass or plastic, per lens

V2715

$9.62

Prism, per lens

V2718

$30.62

Press-on lens, Fresnel prism, per lens

V2730

$17.92

Special base curve, glass or plastic, per lens

V2744

$13.60

Tint, photochromatic, per lens

V2745

$8.45

Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens

V2750

$15.82

Antireflective coating, per lens

V2755

$18.35

U-V lens, per lens

V2760

$13.98

Scratch resistant coating, per lens

V2770

$21.58

Occluder lens, per lens

V2780

$11.38

Oversize lens, per lens

V2781

I.C.

Progressive lens, per lens

V2785

I.C.

Processing, preserving and transporting corneal tissue

V2788

I.C.

Presbyopia correcting function of intraocular lens

V2799

I.C.

Vision item or service, miscellaneous