1. David Eilbert
   Posted 6 months ago #
   

   I'm trying to to find the region-adjusted fees for fitting of soft or gas permeable lenses for aphakia, as well as the material cost for them. Can I bill the fitting separate from the comprehensive exam, and the materials?

2. SuperCoder
   Posted 6 months ago #
   

   There are different ways Fees are calculated for the said purpose, for example: Contact Lens Evaluation Fee
   Global Fees, and Service-Based.
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   What you are talking about is primarily Service-Based Fees where a more common method of structuring professional fees is to separate out each lens modality and charge for fittings based on the lens type. For example, you would charge different fees for fitting spherical, extended wear, toric, daily disposable and multifocal lenses. Frequently this fee covers the fitting process and follow-up visits but does not include the cost of the comprehensive eye examination, contact lens supply or solution. This allows for varied charges for more complex fitting modalities. Practitioners generally have an idea as to the complexity of the fitting system and the number of follow-up visits that may be anticipated when setting the value of their professional fee. However, exceptions occur with some patients requiring more visits and some less.
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   According to the CPT definition of a contact lens fitting fee, it includes the prescription of optical and physical characteristics, with medical supervision of adaptation. The fitting also includes instruction and training as well as incidental revision of the lens during the training period. An additional fitting fee should be billed if you have performed more than one incidental revision of the lens.
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   With this fee structure you should also bill patients for the appropriate office visit such as a comprehensive eye examination, evaluation and management visit or consultation visit. Other billable services or procedures may include the refraction, topography, anterior segment photography or wave-front aberrometry. Table 1 lists common office visit procedural codes and Table 2 lists procedural codes you can use for a contact lens examination in addition to those for the office visit.

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