Why codes matter to you
Every insurance claim is built from codes. Knowing what they mean helps you read an estimate or an explanation of benefits, and lets you ask your plan exact questions like “Is V2531 covered for my diagnosis?” instead of “Do you cover scleral lenses?”
Picking the codes is the practice’s job, based on what was done and documented. This page is for understanding the paperwork, not for choosing codes.
The three kinds of code on a scleral lens claim
- Procedure codes (CPT) describe the professional service, such as the contact lens fitting. They are defined by the American Medical Association.[3]
- Supply codes (HCPCS Level II) describe items, such as the lens itself. Contact lens codes start with V.
- Diagnosis codes (ICD-10) say why the service was needed. Keratoconus, for example, falls under the H18.6 range.[1]
Lens codes payers list
These descriptions are as published in payer policies we read.[1][2]
| Code | Description |
|---|---|
| V2531 | Contact lens, scleral, gas permeable, per lens |
| V2530 | Contact lens, scleral, gas impermeable, per lens |
| S0515 | Scleral lens, liquid bandage device, per lens |
| V2599 | Contact lens, other type |
Scleral lenses made of gas permeable material fall under V2531. One vision plan’s policy lists V2531 for both keratoconus and ocular surface disease fittings.[2] Its policy also requires modifiers on contact lens codes to mark the right eye, the left eye, or both.[2]
Fitting codes payers list
| Code | Description (as listed by payers) |
|---|---|
| 92071 | Fitting of contact lens for treatment of ocular surface disease |
| 92072 | Fitting of contact lens for management of keratoconus, initial fitting |
| 92310 | Prescription and fitting of contact lens with medical supervision of adaptation; corneal lens, both eyes, except for aphakia |
| 92313 | Prescription and fitting of contact lens with medical supervision of adaptation; corneoscleral lens |
| 92325 | Modification of contact lens, with medical supervision of adaptation |
| 92326 | Replacement of contact lens |
Sources: Aetna and Davis Vision policies.[1][2] Descriptions are shortened in places. Which code applies to your fitting depends on your diagnosis, what was done, and your plan’s rules.
Related services may be billed separately. For example, Aetna’s policy lists computerized corneal topography (92025) among the services covered for evaluating keratoconus and other irregular corneas.[1]
A correct code isn’t a covered claim
The code says what was done. Your plan decides whether to pay for it. In Aetna’s policy, for example, V2531 appears among the codes covered when scleral lenses are used as a bandage for severe ocular surface disease, while lenses for keratoconus are not covered under medical plans that exclude contact lenses.[1] The same code can lead to different results depending on the diagnosis and the plan.
What to ask the practice
- Which procedure and lens codes do you expect to bill for my fitting?
- Which diagnosis codes will you use?
- Will remakes during the fitting be billed separately?
- Can I have the codes in writing so I can check my benefits?
What to ask your plan
- Is [the lens code] covered for [the diagnosis code]? Under my medical or vision benefit?
- Is [the fitting code] covered, and how often?
- Is prior authorization needed for either?
- What is the allowed amount, and what will I owe in network and out of network?
Common questions
Should I tell my fitter which code to use?
No. Coding has to match what was actually done and documented, and that's the practice's responsibility. What you can do is ask which codes they plan to use, so you can check your benefits for those codes.
Why does my bill list a code twice?
Lens codes are billed per lens, so a pair is often two lines, with modifiers marking the right and left eye. Remade lenses during a fitting can also appear separately, depending on the practice's billing.
The plan paid the fitting but not the lenses. Is that a coding error?
Not necessarily. Some medical plans cover the fitting for a diagnosis like keratoconus but exclude the lenses themselves, leaving them to a vision plan. Ask the plan which exclusion or limit it applied.
Are these codes the same for every insurer?
The code sets are national standards, but each plan decides which codes it covers, for which diagnoses, and how much it pays. That's why the same code can be paid by one plan and denied by another.