Through post-payment review of claims, Wyoming Medicaid has identified over-billing of lenses when providers are billing for a pair of eye glasses. The claims system has allowed multiple lens codes to be billed and paid to providers when billing for High Index Aspheric lenses. Providers have billed codes V2100-V2399 as the base lenses and additionally billed V2410-V2499 as an "add-on" when the client's prescription qualified for a High Index Aspheric lens. V2410-V2499 are not "add-ons" to regular lenses and should be billed as the lens prescribed for the client alone. Wyoming Medicaid policy's intent is that providers will only bill for the number of items that are dispensed to clients. When eye glasses are provided to a client, only 2 lenses are provided therefore only 2 units of any lens codes (V2100-V2499) may be billed for a client when ordering glasses.
Updates to the CMS-1500 policy manual have been made and system edits have been established to deny when more than 2 units of any lens are billed. Providers who have billed and been paid for more than 2 units on a pair of eye glasses are expected to perform self-audits and submit adjustments to these claims. Providers will be contacted and educated on how to submit these adjustments.
Update to Vision Services - Add-Ons
Wyoming Medicaid has updated the provider manual to include information about prescription add-ons to eye glasses and how to obtain a prior authorization (PA) for these additional services. Please review vision services of the CMS-1500 provider manual.
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