Provider Notice issued 04/15/08

Changes in Billing Policy for Vision Examination Code and Additional Dispensing Fee Code for Bifocals

This notice advises providers of changes to the department’s billing policy for vision services.

Since April 1, 2004, the department has instructed providers to utilize procedure code 92015 with modifier 22 to designate a full optometric examination.  Effective immediately, the department will no longer provide additional reimbursement for modifier 22 billed in conjunction with procedure code 92015.  Instead, providers should use one of the following combinations of codes to designate a full optometric exam:

Procedure code 92015 –Determination of Refractive State, with

• The appropriate Evaluation and Management code in the Current Procedural Terminology (CPT®), Fourth Edition, or

• One of the general ophthalmological services codes in range 92002 through 92014 of the CPT.

Providers should follow the CPT definitions of services and bill the code for the level of service rendered.  The codes may be billed on the paper HFS 2360 claim form or in the 837P electronic claim format.

Additional Dispensing Fee Code

The department has added procedure code 92341 – Fitting of Spectacles, Bifocal as the appropriate dispensing fee code for the ordering of bifocal eyeglasses.  The appropriate dispensing code, either 92340 or 92341, must be billed on the HFS 1443 paper claim form with the Optical Prescription Order (OPO).

Providers are reminded that if eyeglasses can be repaired, procedure code 92370 – Repair and Refitting Spectacles is the appropriate code to bill on the HFS 1443, with an OPO, to request replacement parts for eyeglasses previously obtained through the Illinois Department of Corrections (IDOC) eyeglasses laboratory. 

NPI Reminder

HFS encourages providers that have not yet obtained NPIs to do so immediately.  To apply for an NPI, visit the National Plan/Provider Enumeration System (NPPES) Web site at: <https://nppes.cms.hhs.gov/>.  Providers who have obtained NPIs, but have not reported their NPI information to HFS should do so immediately.  You may report your NPI information by going to the MEDI Web site at: www.myhfs.illinois.gov.

In addition, providers should ensure that all of their payees have obtained and reported their NPIs to the department.  The informational notice on the NPI requirement sent to payees can be accessed on the department’s Web site at: <http://www.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx>.

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 877-782-5565.

Theresa Eagleson, Administrator

Division of Medical Programs