Computer VisionCare services are usually provided at the same time as your patient’s routine eye exam to treat Computer Vision Syndrome (CVS). There are two Computer VisionCare plans: Supplemental Computer VisionCare and Computer VisionCare Only.

Coordination of Benefits

There’s no coordination of benefits for services provided under the Computer VisionCare Plan.

Computer VisionCare patients should complete a questionnaire about their work environments and viewing distance from the computer before the exam. A sample Computer VisionCare Questionnaire can be found in the Patient Education section in the Forms Library area under Administration on VSPOnline on eyefinity.com. Keep a copy of the questionnaire or the information in your patient’s record.

Supplemental Computer VisionCare patients are eligible for a supplemental exam to determine computer vision requirements in addition to the tests listed below.

Computer VisionCare Only: Patients receive a comprehensive exam and the tests listed below.

Additional Tests and Records

In addition to services provided under the VSP Signature Plan^®, include the following tests and records with the Computer VisionCare eye exam:

• history, including viewing distances, lighting, viewing angles, and symptoms
• vision assessment (at least two of the following):
• Function (at least two of the following):
• determination at computer viewing distance eye discussion, when indicated (only during initial visit; no coverage for ongoing treatment)
• testing as indicated, to support the diagnosis
• Near point of convergence test
• Cover test or heterophoria test at the near working distance of the computer monitor
• Fusion quality (assessment of fusion ranges when indicated)
• Facility of accommodation
• Amplitude of accommodation
• Plus and minus lenses to blur at the computer monitor working distance

Treatment requirements

• if computer glasses are indicated
• prescription, if indicated
• regarding the visual environment and workstation
• eye discussion, when indicated
• therapy, when indicated

Patients qualify for Computer VisionCare materials only if they have one of the following diagnoses. Claims require at least one of the following diagnosis codes.

Lenses

Under both plans, patients are eligible for covered lenses and a wholesale/retail frame allowance. Value-Added benefits don’t apply. Materials prescribed are for computer use only.

Spectacle lens coverage includes:

• prescription of ±0.50 diopters or greater required for lenses.
• vision, bifocal, and trifocal specifically designed for working at a computer glass/plastic.
• Variable Focus lenses (VSP lens enhancement code IA or IL) are covered

• sizes up to and including 60 mm.
• prescription for supplemental Computer VisionCare materials must differ by ±0.50 diopters or greater at any distance from the patient’s everyday eyewear.

• I, II or Rose tints, up to 20% absorption level.

Frame

Most VSP plans provide a blended wholesale/retail allowance toward the purchase of a new frame. Patients may also use a serviceable existing frame. If the member chooses a frame with a cost that exceeds both the wholesale and retail allowances, deduct 20% from the retail overage

Other Lens Enhancements

If your patient selects a lens enhancement that is covered with copay, charge your patient according to the VSP Signature Plan Lens Enhancements Chart or your U&C, whichever is lower. Examples of lens enhancements patients can choose:

Non-covered Materials

The following items aren’t benefits under the Computer VisionCare Plan. Clients may make exceptions to this list. Please check the Patient Record Report for coverage. If these items are provided, the lenses and frame will be denied.

• VSP contract labs.
• orders through eClaim at eyefinity.com.
• redos, please check the First-Time Doctor Redos policy in Dispensing and Patient Lens Enhancements section.
• can use non-contract labs in emergency situations only.
• in-office lens enhancements are acceptable if they follow Computer VisionCare guidelines for tints. See Doctor In-Office Lens Enhancements for details.

Claims submitted under the Computer VisionCare Plan must meet the following criteria:

• materials prescribed are for computer use only.
• include at least one of the diagnoses listed above
• prescription for Computer VisionCare materials must differ by more than ±0.50 diopters from your patient’s everyday eyewear
• patient can’t get Computer VisionCare glasses that are the same as everyday eyewear.

VSP will verify that Computer VisionCare glasses meet all requirements. Paid materials claims that don’t meet the above criteria may be reversed. You may not bill your patients for claims that are reversed.

If your patient can’t adjust to occupational progressive lens, benefits won’t be reinstated. Payment becomes a private transaction between you and your patient.

Claim Reimbursement

Supplemental Computer VisionCare: When your patient has Supplemental Computer VisionCare coverage, use their routine benefit for the eye exam and the Computer VisionCare coverage for supplemental Computer Vision Syndrome testing.

Please refer to the chart below to determine your reimbursement:

When possible, perform your supplemental and comprehensive or intermediate exams in the same visit.

*If you choose to use 920XX codes to bill your WellVision Exams, please remember to bill refraction (92015) separately for accurate reimbursement.

Computer VisionCare Only: We’ll reimburse you for exams at your VSP Signature Plan comprehensive or intermediate exam payable fee.

Computer VisionCare-related vision therapy provides evaluations and orthopic and/or pleoptic sessions for patients with one of the following conditions:

• insufficiency— H51.11
• insufficiency— H52.521, H52.522, H52.523
• spasm— H52.531, H52.532, H52.533

Computer VisionCare-related vision therapy provides evaluations and orthopic and/or pleoptic sessions for patients with one of the following conditions:

• insufficiency—378.83
• insufficiency—367.50
• spasm—367.53

If your patient meets the benefit criteria above and is eligible for Computer VisionCare-related vision therapy, please refer to the Vision Therapy section of this manual for billing instructions.

Coverage:

• will pay up to a maximum of $200.
• $200 allowance includes any supplemental testing. VSP does not provide coverage for supplemental testing without treatment.
• patient is responsible for additional therapy above the $200 allowance.
• additional copay is required.

See Services Subject to Review/Audit for information regarding material record keeping requirements.