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Official Description

Variable asphericity lens, single vision, full field, glass or plastic, per lens
Short Descr Lens variab asphericity sing
Coverage Carrier Priced
Pricing Indicator(s) 38 – Supplies And Surgical Dressings - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1F – Prosthetic/Orthotic devices
TOS Code(s) Q – Vision items or services
Added Date 1/1/1984
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 0
MUE 2
OTS Orthotic No
CCS Clinical Classification 241 - Visual aids and other optical supplies
EY No physician or other licensed health care provider order for this item or service
GA Waiver of liability statement issued as required by payer policy, individual case
GZ Item or service expected to be denied as not reasonable and necessary
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
RA Replacement of a dme, orthotic or prosthetic item
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
1984-01-01 Added Code added 1/1/1984
Code
Description
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