Audience: Participating Vision Care Providers
We would like to make you aware of an update to the polycarbonate lenses procedure code for Child Health Plus (CHP), Medicaid Managed Care (MMC), and Health and Recovery Plan (HARP) members. This applies to our members with Child Health Plus, HMOBlue Option, Blue Choice Option, Blue Option Plus, Premier Child Health Plus, Premier Option, or Premier Option Plus coverage.
For eligible CHP, MMC or HARP members receiving polycarbonate lenses, submit the claim with procedure code S0580 (polycarbonate lens). List code S0580 in addition to the basic code for the lens. Do not submit code V2784 (lens, polycarbonate or equal, any index, per lens) as that will cause the claim to deny.
- For children and adolescents up to 21 years of age, polycarbonate lenses are covered if needed for safety reasons. Medical documentation is not necessary.
- For adult enrollees (persons 21 years or older), the member must be essentially monocular with functional vision in only one eye or have a history of auto-aggressive behavior with a history of breaking glasses. Documentation, including a diagnosis, must be submitted with claims for members 21 and over. The statement qualifying the member’s vision should be from an ophthalmologist or optometrist.
Log into our website, Provider.ExcellusBCBS.com, to obtain patient vision eligibility and benefits prior to rendering service. Additional eligibility and vision billing information for MMC and HARP members is available from eMedNY, the Medicaid eligibility verification system. Go to:
We have a Vision Eligibility & Benefits Tip Sheet available on our websiteOpen a PDF to assist you.
Please share this important information with all office locations. Thank you for the quality of care and service that you provide to our valued members.Email this article