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EYEMED ACCEPTABLE SERVICE CODES

EYEMED ACCEPTABLE SERVICE CODES . Effective 10/16/03. Exam & Fit/Follow Up Services ACCEPTABLE Code Modifier 92002 New Intermediate 92004 New Comprehensive 92012 Established Intermediate 92014 Established Comprehensive S0620 Routine Opthalmological - New Patient S0621 Routine Opthalmological - Established Patient 92015 TG VDT Refraction (Valid only on certain plans). 92310 Prescription, fitting & dispensing of contacts by doctor 92314 Prescription, fitting & dispensing of contacts by tech S0592 Comprehensive Contact Lens Evaluation Contact Lens Materials ACCEPTABLE Code Modifier S0500 ALL DISPOSABLE/PLANNED REPLACEMENT CONTACTS. S0512 DAILY WEAR SPECIALTY CONTACTS. V2330 CONTACT LENS, SCLERAL. V2500 PMMA, SPHERICAL. V2501 PMMA TORIC OR PRISM BALLA. V2502 PMMA, BIFOCAL. V2503 PMMA, COLOR VISION DEFIC Please Note: A "D" after the V2510 GAS PERMEABLE, SPHERICAL "V" code will no longer V2511 GAS PERM, TORIC, PRISM identify the contacts as V2512 GAS PERMEABLE, BIFOCAL a disposable contact lens.

Acceptable Code Modifier V2219 Seg.width>28mm (explanation required) V2219 Flat Top 35 V2219 Executive V2220 Add >3.25D V2319 Seg.width>28mm (explanation required) V2319 Flat Top 35 V2319 Executive V2320 Add >3.25D Lens Add On and Material Codes Acceptable Code Modifier V2799 Glass Lenses V2780 Oversize V2760 Scratch Coating

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EYEMED ACCEPTABLE SERVICE CODES

www.eyemedvisioncare.com

EYEMED ACCEPTABLE SERVICE CODES Effective 10/16/03 Plastic Progressive Lenses Acceptable Code Modifier V2781 Standard Progressive Lens Please refer to your Provider Manual V2781 \ for the complete list of approved | ----- Premium Progressive Lens premium progressive lenses S0581 /

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Got questions? We’ve got answers. - EyeMed …

www.eyemedvisioncare.com

Got questions? We’ve got answers. How do I use my benefits? Simply find a doctor, schedule an appointment and receive services. We’ll handle all the paperwork, when you visit an in-network provider.

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Integration Questions and Answers - EyeMed …

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Integration Questions and Answers Clients • Will the vision care network of providers change, and if so, when can my members have access to a new panel? The integration of Cole and EyeMed will bring many new opportunities to current

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Out of Network Vision Services Claim Form

www.eyemedvisioncare.com

OUT-OF-NETWORK VISION SERVICES CLAIM FORM Claim submissions made easy WENT OUT-OF-NETWORK? NO PROBLEM, LET’S WALK THROUGH IT If you …

  Form, Claim form, Claim, Made, Submissions, Vision, Claim form claim submissions made

NETWORK PROVIDER LOCATIONS Tennessee

www.eyemedvisioncare.com

network provider locations tennessee page 2 november 2010 thomas k smith 592 n main st (731) 352-2020 mc kenzie, tn 38201 city of elizabethton duane e lowry od 920 west g st (423) 543-2020 elizabethton, tn 37643

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