Billing for Vision Appliances

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

Select HMSA plans cover vision appliances that are rendered in connection with an eye examination and are necessary to correct a visual defect. A valid prescription is required to dispense appliances and must be kept as part of the medical record to support the billing of eye appliances. If there is no evidence of a vision exam, the prescription will be required. Such appliances are subject to plan deductibles and coinsurance percentages.

Vision plans with frame benefits of one every 24 months have a service date specific limitation.

Example: If frames are purchased on 12/12/2019, the next available benefit will be after 12/12/2021.

Filing Instructions for Vision Prescription

Block 15 on the CMS 1500 claim form is used for information related to the patient’s condition. This block can be used to enter in the prescription information. The “Other Date” field is completed with these details. Use qualifier 471 and indicate the date that the prescription was issued or the prescription effective date.

For more information on filing EDI claims, visit our Claims Filing Information page.

Billing for Frames Outside of the Standard Selection

Nonstandard frames should be billed on two service lines of the CMS 1500 claim form. On the first service line (column 24D), enter HCPCS code V2020, which represents a standard frame. On the second service line, enter HCPCS code V2025, which represents a deluxe or nonstandard frame.

When entering the charges in column 24F, split the total charge. The charges for the standard portion of the frame should be entered on the first service line, and the charge for the nonstandard portion of the frame 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, except for plans that cover deluxe frames. Always refer to member's Guide To Benefit.

Example

If a patient selected a frame priced at $109.93, and the provider has agreed with HMSA to accept $55 for a "standard" frame, the frame would be billed as shown below. The standard portion of the charge ($55) is billed on the first line, and the nonstandard portion of the charge (the remaining $54.93) 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