Elective Contact Lens Covered in Full Exception Clients
This information applies only to those clients with Elective Contact Lens (ECL) covered-in-full exceptions. These clients require that an annual supply of ECL contacts be covered in full to your patient.
For complete ECL information, refer to “Contact Lens Plans" in the Plans & Coverages section.
Submitting the Claim
Eye Exam
Use your patient’s exam benefit to bill for the routine exam.
CONTACT LENS SERVICES
Bill the right CPT code and your U&C fees for the contact lens services.
Contact Lens Materials
Bill the right HCPCs code(s) for provided materials. Submit your U&C fees for materials and indicate the number of units (contact lenses) dispensed.
Contact Lens Type
Based on the number of units dispensed, indicate the correct type of lenses:
- 1–2 units: Conventional or non-disposable contacts
- 3–52 units: Planned replacement, month/quarter, or 14-day disposables
- 53–106 units: 7-day disposables
- 107–361+ units: 1-day disposables
Reimbursement
VSP Payment
We’ll pay you 85% of your contact lens service fees plus your U&C fees for materials up to the maximum amount for the type of contact lenses provided. We’ll pay separately for a routine exam.
Note:
Unless otherwise indicated on the Patient Record Report, there are no benefits for professional services or materials connected with the following:
Corneal Refractive Therapy, Orthokeratology, and myopia management.
Copay
Collect any applicable copays from your patient.
Balance Billing
Don’t bill your patient for the contact lens services or the annual supply of contact lenses. You must accept payment from us as payment in full for services rendered and make no additional charge to the patient for covered services.