92071_R37

This Medicare carrier does not have a local coverage determination (LCD) for bandage contact lenses.  The policy presented is a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.  

The patient’s medical record should indicate the symptoms that necessitate the prescribing of a bandage contact lens. Also, when appropriate, the medical record should indicate that more conservative management has failed to resolve the condition.

There is usually a need for frequent monitoring of the cornea while using a bandage contact lens and the contact lens may be replaced as often as it is reasonable and medically necessary.

Medicare’s National Coverage Determinations describes covered uses of bandage contact lenses: “Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology.  The term “hydrophilic contact lens” doesn’t include corneal collagen shields as bandage contact lenses.  The Indications and Limitations of Coverage listed in the NCD provides special instructions about reimbursement for bandage contact lenses. It states:

“Payment may be made under §1861(s)(2) of the Act for hydrophilic contact lens approved by the FDA and used as a supply incident to a physician’s service. Payment for the lens is included in the payment for the physician’s service to which the lens is incident.”

The “incident to” phrase is key, and the Medicare Carriers Manual §2050.1 defines “incident to” services: “Incident to a physician’s professional services means that the services or supplies are furnished as an integral although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness.”  In this context, the service is 92071 (fitting of contact lens, etc.), so it’s not appropriate to make a separate claim for the bandage contact lens supply.

• Report bandage contact lens with CPT code 92071
• This is a unilateral service, therefore the -RT or -LT modifiers must be utilized if only one eye is being treated and a unit of “1” is placed in the unit field of the CMS 1500 form or its electronic equivalent
• If both eyes are treated, append modifier -50 to the service line and a unit of “1” is placed in the unit filed of the CMS 1500 form or its electronic equivalent
• An eye examination may be reported on the same day as a bandage contact lens fitting if it is medically necessary

The frequency with which procedure code 92071 is performed is based on the patient’s underlying condition and their individual response to treatment. In the absence of a specific policy, utilization of these services should be consistent with locally acceptable standards of ophthalmic practice.