Don’t charge a fee for any lens enhancements covered by your patient’s plan. We’ll pay you a service fee, as shown on the VSP Signature Lens Enhancements Chart. Please note that if your patient is covered for plastic dyes, glass tints, or plastic or glass photochromics, there’s no service fee for these lens enhancements. There’s also no service fee for covered polycarbonate lenses when dispensed to children or handicapped patients.

Polycarbonate lenses for monocular patients

Don’t charge for the polycarbonate lens enhancement used by functionally monocular patients, defined as those having best corrected vision of 20/200 or worse in one eye. Polycarbonate lenses are covered.

We’ll cover the lens enhancement fee, even if it’s not specifically covered by your patient’s plan. We’ll also pay you a service fee. Simply include the most appropriate ICD-10 diagnosis code describing your patient’s level of visual impairment on the claim form.

Monocular Diagnosis Codes:

The claim must be submitted with a polycarbonate lens enhancement and one of the following monocular diagnosis codes: H54.10, H54.40, H54.1131-H54.2X22, H54.413A-H54.415A and H54.42A3-H54.42A5.

For lens enhancements that are covered with a copay, charge the patient according to the VSP Signature Lens Enhancements Chart or your U&C fee (whichever is lower). However, if a client has selected to cover a lens enhancement in full with a specific copay, collect the indicated copay.

Determining What to Charge the Patient

VSP patient copays are all add-on fees. Your private-pay lens enhancement fees may be an add-on to your lens fee or included in your total lens fee. Example A shown below explains what to charge your patient when your U&C add-on fees are higher than VSP’s Patient Lens Enhancement fees. Example B explains what to charge your patient when your U&C add-on fees are lower than VSP’s Patient Lens Enhancement fees.

Examples

To offer more customized coverage to VSP Vision Care clients and members, we’ve developed several flexible lens enhancements programs that allow partial coverage for the most popular VSP lens enhancements, including anti-reflective (AR) coatings, photochromics, and progressives. Always refer to the online Patient Record Report and Lens Enhancements Charges report for complete information on lens enhancement coverage. Client specific copays will display under the heading Covered with Additional Copay, see amount followed by the specific lens enhancement and copay. Charge your patient the indicated amount. The VSP Flexible Lens Enhancement Coverage Tip Sheet provides more information and helps you calculate patients' out-of-pocket expenses.

Even though your patient can request a single lens instead of a pair of lenses, VSP doctors and labs are reimbursed for a complete pair of lenses. If your patient only orders one lens and then needs a second lens within 12 months, your patient is entitled to a second lens at no additional cost.

If your patient gets a lens enhancement on a single lens order, charge them the full patient-lens enhancement price.

There may be instances where a patient ordering two prescription lenses, might only need a particular lens enhancement on one of the lenses, such as one plastic progressive lens and one single-vision plastic lens.

Patient Charges

If the lens enhancement is covered, don’t charge the patient. For other lens enhancements, charge the patient half of the VSP Patient Copay. Only half of the chargeback will be deducted from your VSP Explanation of Payment.

Claim Submission

When you submit orders electronically, indicate in Box 19 on the CMS-1500 Form “half-pair lens enhancement” and clearly describe half lens enhancement in Lab Special Instruction area, including which lens has the enhancement; left or right. If one lens is progressive and one is single vision, be sure to bill both lenses as progressive. Eyefinity will not accept SVL in one eye and progressive in the other.

When you submit a paper claim, indicate in Box 19 on the CMS-1500 “half-pair lens enhancement”, indicate left or right eye and include the lab invoice.