Billing for Deluxe Intraocular Lens (IOL) - Private Business

HMSA members have the option to get a deluxe intraocular lens (IOL) associated with cataract surgery. HMSA will cover the medically necessary standard IOL and the member will be held liable for the difference in cost for the added deluxe IOL functionality.

Deluxe IOL implants should be billed on two separate service lines of the CMS 1500 or UB-04 claims forms. On the first service line, enter the appropriate code for the standard IOL (i.e. V2630, V2631, V2632). On the second service line, enter the code for the deluxe IOL functionality (i.e. V2787, V2788). A standard IOL code must always be billed because the actual contact lens is applicable only to this service. The deluxe IOL codes are for the added functionality but do NOT include the actual lens itself.

NOTE: In addition to the appropriate HCPC code, facilities billing on a UB-04 claim must use revenue code 276 to bill intraocular lenses along with the appropriate RT or LT modifiers.

Examples

The following example illustrates how to bill for deluxe intraocular lens on a UB-04 claim form:

The following example illustrates how to bill for deluxe intraocular lens on a CMS 1500 claim form:

In both examples, the first service line will be processed for payment based on the established rate and member’s plan benefit. The second service will be denied, and the member will be responsible for the billed charge.

The dollar amounts shown in the above examples are for illustration purposes only.

Please be sure to use the most up-to-date industry-standard procedure, revenue, and diagnosis codes from the current CPT ®'', HCPCS Level II, and ICD-10-CM manuals, as recommended by the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and the American Hospital Association.

** Codes may not be all inclusive as the AMA and CMS code updates may occur more frequently.

Revision History