are contact lenses medically necessary
Individuals who require some sort of vision correction can misunderstand the phrase medically necessary contact lenses. The phrase is only applied to individuals where standard glasses are not a medically accepted alternative to contact lenses. Money from the FSA can be applied toward the eye exam copay, out-of-pocket costs for prescription glasses or contact lenses (including upgrades) and supplies such as contact lens solution. Employees can even use FSA funds for LASIK surgery. Medically necessary contact lenses usually offer the wearer greater visual acuity than eyeglasses can provide. Contact lenses may be used as an alternative to replacing the lens of the eye for some eye conditions and may be needed after some optical surgical procedures like cataract removal. Each health care plan has different coverage levels and qualifications for medically necessary contact lens coverage. Many health insurance companies will cover medically necessary contact lenses, even if the policy does not cover standard contact lenses. CPT Codes for Medically Necessary Prescribing. Preamble for the 9231X Codes. “The prescription of contact lenses includes specification of optical and physical characteristics (such as. power, size, curvature, flexibility, gas-permeability). It is NOT a part of the general ophthalmological. services. Insurance companies use the phrase medically necessary contact lenses to determine payment levels for contact lenses. Typically, medically necessary lenses are covered at a higher rate than cosmetic contact lenses. Bifocal Lenses - Lenses prescribed for those who need correction for both far away and up close. Claim - A request for payment of benefits. Conventional Contact Lenses - Contact lenses designed for long-term use (up to one year); can be either daily or extended wear. Copay - A specified dollar amount a member must pay out-of-pocket for a specified service at the time of service. Visually Necessary Contact Lenses. • Prior authorization is no longer required, but it’s advisable to check the online portal. or call to verify the benefits and coverage of. each patient. • Must fill out Medically Necessary Contact. Lens Claim Form and fax to 866.293.7373. One benefit per calendar year. Insurance companies consider standard contact lenses a cosmetic choice rather than a medical need. However, for some individuals with specific vision conditions, contact lenses are considered a medical necessity. It’s about your health! An eye exam can detect eye health problems like glaucoma or cataracts, but it can also help identify early signs of diseases that impact your whole body- high blood pressure, diabetes and high cholesterol – just to name a few. So, schedule an exam today and keep an eye on your health.
Yes, contact lenses are medically necessary.