JUN 09, 2023
Coding Medically Necessary Contacts for an Infant With Aphakia
How would we bill medically necessary contact lenses for an aphakia infant?
Answer:Utilize HCPCS code V2523 contact lens, hydrophilic, extended wear, per lens with Aphakia (ICD-10 codes H27.00-H27.03) as the primary diagnosis linked to V2523.
Commercial payers will have their own unique coverage policies which define medical necessity, example: Aetna’s Clinical Policy Bulletin,
(CPB) 0126: Contact Lenses and Eyeglasses.
When it’s a covered service, the claim will be paid according to participating providers' contracted rates. A member is not responsible for the difference between the amount billed and the contracted rate.