Billing for Progressive 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

Contact by phone

For Providers: 1-888-259-4344

Progressive lenses should be billed using two service lines on the CMS 1500 claim form. On the first service line, enter the appropriate HCPCS code for bifocal or trifocal lenses. On the second service line, enter V2781 to indicate that the lenses dispensed were progressive lenses.

When entering the charges in column 24F, split the total charge. The charges for the standard bifocal or trifocal lens should be entered on the first service line, and the remaining charge attributable to the progressive construction 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. In most cases, the second service line will be denied, and the member will be responsible for the billed charge.

Example

If a patient selects bifocal lenses priced at $120 and the provider would have billed HMSA $80 for "standard lenses," the lenses would be billed as follows. The standard portion of the charge ($80) is billed on the first line, and the nonstandard portion of the charge (the remaining $40) 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