|
| Examination, Treatment and Procedures |
| | |
| Procedure Code | 2024-25 UEC Fee
(US dollars) | Description |
| 0207T | 225 | Lipiflow Treatment (per eye)
(Clear eyelid gland with heat) |
| 64612 | 250 | Destroy nerve, face muscle |
| 65205 | 125 | Foreign Body Removal, Conjunctival, Superficial |
| 65210 | 125 | Foreign Body Removal, Conjunctival, Embedded |
| 65222 | 125 | Foreign Body Removal, Corneal, Slit Lamp |
| 65430 | 500 | Corneal Scraping, Diagnostic, Smear or Culture |
| 65600 | 650 | Stromal Puncture |
| 65778 | 1,900 | Prokera (Amniotic Membrane) |
| 65855 | 700 | Trabeculoplasty By Laser |
| 66761 | 700 | Iridotomy/Iridectomy, By Laser |
| 66821 | 725 | Laser Surgery, Lens (YAG) |
| 66984 55 (modifier 55 for comanagement) | 210 | Comanagement of Post-Op Portion of Extracapsular Cataract Removal With Insertion of IOL |
| 67028 | 310 | Injection Eye Drug |
| 67105 | 750 | Retina or Choroid Repair, Photocoagulation |
| 67145 | 750 | Retina or Choroid Prophylaxis, Photocoagulation |
| 67210 | 775 | Retina or Choroid Destruction, Localized Lesion, Photocoagulation |
| 67228 | 1,200 | Retina or Choroid Destruction, Treatment of Extensive Retinopathy,
Photocoagulation |
| 67515 | 150 | Injection of Medication or Other Substance Into Tenons Capsule |
| 67800 | 275 | Excision of Chalazion, Single |
| 67805 | 500 | Excision of Chalazion, Multiple, Different Lids |
| 67820 | 100 | Correction of Trichiasis, Epilation, Forceps |
| 67825 | 250 | Correction of trichiasis; epilation, by
methods other than forceps (e.g., electrosurgery) |
| 67840 | 650 | Excision of Lesion of Eyelid (Except
Chalzaion) Without Closure or With Simple Direct Closure |
| 68761 | 300 | Closure of Lacrimal Punctum by Plug |
| 68801 | 175 | Dilation of Lacrimal Punctum, With or Without Irrigation |
| 68840 | 235 | Probing of Lacrimal Canaliculi, With or Without Irrigation |
| 76510 | 250 | Ophthalmic Ultrasound, Diagnostic, B- scan and Quantitative A-scan Performed During Same Patient Encounter |
| 76511 | 165 | Ophthalmic Ultrasound, Quantitative A- scan Only |
| 76512 | 165 | Ophthalmic Ultrasound, B-scan, With or Without Non-quantitative A-scan |
| 76513 | 200 | Anterior Segment Ultrasound, Immersion B-scan or High Resolution Biomicroscopy |
| 76514 | 60 | Corneal Pachymetry, Unilateral or Bilateral |
| 76519 | 130 | Ophthalmic Biometry by Ultrasound, A-scan, With IOP Power Calculation |
| 83516 | 40 | Immunoassay for Other Than Infectious Agent (InflammaDry) |
| 83861 | 50 | Tear Osmolarity Testing |
| 90791 | 400 | Psychiatric Diagnostic Evaluation (Intake Interview) |
| 92000 | 300 | Perceptual Evaluation |
| 92000HT | 200 | Perceptual Eval/Skills |
| 92002 | 135 | Ophthalmological Services, Intermediate, New Patient |
| 92004 | 200 | Ophthalmological Services, Comprehensive, New Patient |
| 92012 | 150 | Ophthalmological Services, Intermediate, Established Patient |
| 92014 | 175 | Ophthalmological Services, Comprehensive, Established Patient |
| 92015 | 65 | Determination of Refractive State |
| 92015-22 | 150 | Determination of Refractive State - Complex |
| 92020 | 75 | Gonioscopy |
| 92025 | 135 | Computerized Corneal Topography |
| 92060 | 125 | Sensorimotor Examination |
| 92065 | 200 | Orthoptic Training |
| 92066 | 150 | Orthoptic Training w/ Technician |
| 92081 | 90 | Visual Field Examination, Limited |
| 92082 | 105 | Visual Field Examination, Intermediate |
| 92083 | 145 | Visual Field Examination, Extended |
| 92100 | 125 | Serial Tonometry |
| 92132 | 105 | Scanning Computerized Ophthalmic Diagnostic Imaging, Anterior Segment |
| 92133 | 125 | Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment, Optic Nerve |
| 92134 | 125 | Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment, Retina |
| 92136 | 170 | Ophthalmic Biometry by Partial Coherence Interferometry With IOL Power Calculation |
| 92145 | 50 | Corneal Hysteresis Determination, By Air Impulse Stimulation |
| 92201 | 75 | Ophthalmoscopy, Extended, Initial |
| 92202 | 65 | Ophthalmoscopy, Extended, Subsequent |
| 92235 | 185 | Fluorescein Angiography |
| 92250 | 225 | Fundus Photography |
| 92270 | 140 | Electro-oculography |
| 92273 | 275 | Electroretinography - Full Field |
| 92274 | 150 | Electroretinography - Multifocal |
| 0509T | 150 | Electroretinography - Pattern |
| 92283 | 225 | Color Vision Eximination, Extended - Adult |
| CVT56 | 100 | Color Vision Eximination, Extended, 5-6yo |
| CVT713 | 150 | Color Vision Eximination, Extended, 7-13yo |
| 92285 | 115 | External Ocular Photography |
| 92286 | 125 | Anterior Segment Imaging, With Specular Microscopy |
| 95930 | 220 | Visually Evoked Potential (VEP) |
| 96132 | 265 | Neuropsychological Testing Evaluation Services by Physician or Other Qualified Health Care Professional, Including Integration of Patient Data, Interpretation of Standardized Test Results and Clinical Data, Clinical Decision Making, Treatment Planning and Report, and Interactive Feedback to the Patient, Family Member(s) or Caregiver(s), When Performed, First Hour |
| 96133 | 185 | Neuropsychological Testing Evaluation Services, Each Additional Hour (Add on Code) |
| 99075 | 500*
250** | Medical Testimony
*Initial, Up to Two Hours / **Each Additional Hour |
| 99202 | 125 | Office Visit, New Patient |
| 99203 | 175 | Office Visit, New Patient |
| 99204 | 250 | Office Visit, New Patient |
| 99205 | 275 | Office Visit, New Patient |
| 99212 | 115 | Office Visit, Established Patient |
| 99213 | 150 | Office Visit, Established Patient |
| 99214 | 200 | Office Visit, Established Patient |
| 99215 | 250 | Office Visit, Established Patient |
| 99241 | 80 | Office Consultation , New or Established Patient |
| 99242 | 125 | Office Consultation , New or Established Patient |
| 99243 | 160 | Office Consultation , New or Established Patient |
| 99244 | 215 | Office Consultation , New or Established Patient |
| 99245 | 280 | Office Consultation , New or Established Patient |
| 99EHV | 100 | External Home Visit |
| J9035 | 125 | Bevacizumab injection (10mg) |
| J0585 | 10 | Botulinum toxin (1unit) |
| J0178 | 1,050 | Eylea (1mg) |
| SHIPS | 25 | Shipping, Standard |
| SHIPO | 70 | Shipping, Expediated |
| VU99203 | 140 | Vuity Initial Visit |
| VU99213 | 110 | Vuity Established Patient Visit |
| VU99212 | 70 | Vuity Recheck |
|
| Contact Lens Services and Materials |
| | |
| Procedure Code | | Description |
| 92071 | 200 | Fitting of Contact Lens for Treatment of Ocular Service Disease (bandage contact lens) |
| 92072 | 800 | Fitting of Contact Lens for Management of Keratoconus, Initial, Bilateral |
| 92310-52 | 400 | Degenerative Myopia Intial Fit (bilateral) |
| 92310 | 800 | Prescription of Optical and Physical Characteristics of and Fitting of Contact Lens, Medically Necessary, Both Eyes (except aphakia) |
| 92311 | 425 | Fitting of Medically Necessary Contact Lens, Aphakia, 1 Eye |
| 92312 | 600 | Fitting of Medically Necessary Contact Lens, Aphakia, Aphakia, Both Eyes |
| 92313 | 400 | Fitting of Medically Necessary Contact Lens, Corneoscleral Lens, 1 Eye |
| V2513 | Starting at 200 per lens | Contact Lens, Rigid Gas Permeable |
| V2521 | Starting at 50 per box | Soft Lenses: Toric |
| V2522 | Starting at 55 per box | Soft Lenses: Multifocal |
| V2523 | Starting at 40 per box | Soft Lenses: Spherical |
| V2599 | Starting at 400 per lens | Contact Lens, Orthokeratology |
| V2531 | Starting at 675 per lens | Scleral Lens |
| V2623 | 2,400 | Prosthetic Eye, Plastic, Custom, Per Eye |
| V2624 | 100 | Polishing/Resurfacing |
| V2625 | 500 | Enlargement Of Ocular Prosthesis |
| V2626 | 500 | Reduction/Ocular Prosthesis |
| V2627 | 2,000 | Sclera Cover Shell |
| CL12 | 600 | Cosmetic Rigid Gas Permeable Contact Lens Professional Fee: Scleral/Hybrid |
| CL14 | 600 | Orthokeratology- Refit Not Including Lenses |
| CL15 | 75 | Intermediate Contact Lens/Eye Health Assessment- Elective Wearer |
| CL101 | 75 | Annual Soft Contact Lens Evaluation During Comprehensive Examination |
| CL102 | 100 | Annual GP Contact Lens Evaluation During Comprehensive Examination |
| CL103 | 150 | Cosmetic Contact Lens Professional Fee: Soft Refit Existing Wearer Same Lens Design in Toric or Multifocal /Rigid Gas Permeable Refit, Change in Power Only |
| CL104 | 150 | Cosmetic Soft Contact Lens Professional Fee: Standard Fit |
| CL105 | 200 | Cosmetic Soft Contact Lens Professional Fee: Premium Fit |
| CL106 | 250 | Cosmetic Rigid Gas Permeable Contact Lens Professional Fee |
| CL108 | 1,400 | Orthokeratology - Initial Fit Not Including Lenses |
| CLKIT | 25 | Scleral Lens Kit |
| CLDMV | 15 | Scleral Lens Insertion and Removal Plungers |
| CLDMVS | 25 | Scleral Lens Insertion Stand |
|
| Vision Rehabilitation Materials |
| | |
| Code | | Description |
| 2266 | 125 | VT Home Therapy Software |
| 2266F | 175 | VT Home Therapy Software with Flippers |
| 2271VT | 120 | VT Kit |
| ED101 | 450 | Educational/Achievment Testing |
| V2600 | Starting at 27 | Hand-held low vision aids and other non spectacle mounted aids |
| V2610 | Starting at 103 | Single lens spectacle mounted low vision aids |
| V2615 | Starting at 98 | Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system |
| V2718 | 50 | Press on lens, Fresnell Prism, Per Lens |
|
| Optical Materials |
| | |
| Code | | Description |
| V2020 | Starting at 80 | Frames |
| V2100 | 75 per pair | SV, sph, plano to +/-4.00 |
| V2200 | Starting at 105 per pair | Bifocal, sph, plano to +/-4.00 |
| V2219 | 40 additional per pair | Seg over 28mm |
| V2220 | 40 additional per pair | Bifocal add +3.25 to +4.00 |
| V2300 | 175 per pair | Trifocal, sph, plano to +/-4.00 |
| V2303 | 175 per pair | Trifocal, spherocyl, plano to +/-4.00 up to 2.00 cyl |
| V2319 | 40 additional per pair | Trifocal seg over 28mm |
| V2320 | 45 additional per pair | Trifocal add over +3.25 to +4.00 |
| V2715 | 20 | Prism per diopter per eye |
| V2718 | 50 per prism | Fresnel Prism |
| V2744 | 120 per pair | Tint, plastic photochromatic |
| V2745 | 25 per pair | Tint, anything except photochromatic |
| V2750 | Range from 100
to 195 per pair | Antireflection coating |
| V2755 | 25 per pair | Ultraviolet coating |
| V2760 | 25 per pair | Scratch resistant coating |
| V2762 | 160 per pair | Polarization |
| V2781 | Starting at 170 additional per pair over fee for
bifocals | Progressive lenses |
| V2782 | 159 per pair | Trivex lenses |
| V2783 | Starting at 160 additional per pair over fee for standard lenses | High Index lenses |
| V2784 | 55 additional per pair | Polycarbonate |
| Kids Packages: Rx range = +/- 4.00 with -2.00 cyl | Starting at 129,149,
189 & 249 | Frame and single-vision polycarbonate lenses |
| Sports Glasses: Rx range = +/- 4.00 with -2.00 cyl | 199 | Select Liberty Sports Goggles and single vision clear polycarbonate lenses |
|
| Telehealth |
| | |
| Procedure Code | | Description |
| 98980 | 30 | Remote Therapeutic Moinitoring |
| 99212 | 100 | Telehealth - Office Visit, Established Patient 10-19 Min |
| 99213 | 130 | Telehealth - Office Visit, Established Patient 20-29 Min |
| 99441 | 100 | Phone, Eval & Management 5-10 Min |
| 99442 | 130 | Phone, Eval & Management 11-20 Min |
| 99443 | 160 | Phone, Eval & Management 21-30 Min |
| 99453 | 35 | Remote monitoring of Physiologic Parameters (i.e., eye pressure) |
| 99454 | 90 | Remote monitoring of Physiologic Parameters (i.e., eye pressure) w/ Loaned Device |
| G2012 | 25 | Brief Check-in (5-10 minutes) |
| G2010 | 20 | Remote Image Review |
| ICHME | 125 | i-Care Home Rental |
|
| Myopia Managment |
| | |
| Procedure Code | | Description |
| MC01 | 75 | Initial Consultation Visit |
| MC02 | 325 | Baseline Evaluation |
| MC03 | 275 | Annual Evaluation |
| CL20 | 300 | Myopia Control Soft Multifocal CL Fit |
| CL21 | 1,400 | Myopia Control Orthokeratology CL Fit Not Including Lenses |
| CL22 | 75 | CL Assessment with Annual Myopia Control Visit |
| CL23 | 200 | Myopia Control Soft Multifocal CL Refit |
| CL24 | 600 | Myopia Control Orthokeratology CL Refit Not Including Lenses |
|
| Medical Records Request Fee |
| | |
| Procedure Code | | Description |
| MRRPE* | A flat rate of $6.50 | Medical Records Request Fee Copies sent via Email |
| MRRPP* |
$0.75 per page | Medical Records Request Fee Print copies |
| MRRPC* | $2.00 for a set (2 pages) | Medical Records Request Fee Color Copies |
| * effective date 3.5.2025 | | |
| | |
| Effective: 07/01/2024 | | |
| | |
