Billing for Nonstandard Lenses

Important Note

HMSA has partnered with EyeMed, service date effective January 1, 2022. HMSA transitioned our current vision portfolio to a new vision benefit with EyeMed for the following line of business: Commercial, Akamai Advantage®, QUEST Integration, Fed 87, and HMSA Plan for Postal Service Employees. HMSA will continue to be the administrators for non-routine vision services through the members medical plan(s). For more information, please contact EyeMed at: www.eyemedinfocus.com

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For Providers: 1-888-259-4344

To bill for nonstandard lenses, such as extra-thin, oversized or ultra-light lenses, use the HCPCS code S0581 in addition to the standard code for the lenses.

Nonstandard lenses should be billed on two service lines of the CMS 1500 Claim Form. On the first service line (column 24D), enter the HCPCS code for the standard lens. On the second service line, enter HCPCS code for the specialty lens.

When entering the charge in column 24F, split the total charge. The charges for the standard portion of the lens should be entered on the first service line, and the charge for the nonstandard portion of the lens should be entered on the second service line.

When the claim is processed, the first service line will be processed for payment to contracted Special Vision providers based on the negotiated rate. The second service line will be denied, and the member will be responsible for the billed charge.

Example

If a patient selects oversized lenses priced at $160 and the provider would have billed HMSA $80 for "standard" lenses, the lenses would be billed as shown below. The standard portion of the charge ($80) is billed on the first line, and the nonstandard portion of the charge (the remaining $80) is billed on the second line.

The dollar amounts shown in the above example are for illustration purposes only and may vary depending on the negotiated arrangement between HMSA and the provider.

Revision History