Cal. Code Regs. Tit. 22, § 51519 - Eye Appliances

(a) General Provisions.

(1) The reimbursement for eye appliances shall be in accordance with maximum reimbursement rates listed below; however, billing shall not exceed charges made to the general public.

(2) The listed allowances include impact resistance and testing, oversize lenses, special beveling, drilling, mounting, fitting and adjusting, loaners for postcataract cases, sales taxes paid by the provider, and follow-up services for a period of six months after date of service.

(3) "Diopters" refers to the power of the strongest meridian of the major portion of the lens, the maximum cylindrical power, or the power of the segment addition, as appropriate.

(4) When a Medi-Cal beneficiary resides in a geographic area where a fabricating optical laboratory has entered into an exclusive area negotiated contract with the Department, the lens dispensing fees listed in Section 51519.1(b) shall be used instead of HCPCS codes V2100 through V2430, and V2700 through V2755 listed in (b) below. When a fabricating optical laboratory, which has entered into an exclusive area negotiated contract with the Department, also supplies the frames, the frame dispensing fee listed in Section 51519.1(b) shall be used instead of HCPCS codes V2020 and Z2910 through Z2916 listed in (b) below.

(b) Maximum reimbursement rates for eye appliances shall be as follows:

Procedure Code			Section Maximum Allowance per Lens
(1) Spectacle Lenses
SINGLE VISION GLASS OR PLASTIC
V2100	Sphere, single vision, plano to plus or minus 4.00, per lens..........................	$18.30
V2101	Sphere, single vision, plus or minus 4.12 to plus or minus 7.00D, per lens..........................	21.69
V2102	Sphere, single vision, plus or minus 7.12 to plus or minus 20.00D, per lens..........................	25.75
V2103	Spherocylinder, single vision, plano to plus or minus 4.00D sphere, .12 to 2.00D cylinder, per lens..........................	18.48
V2104	Spherocylinder, single vision, plano to plus or minus 4.00D sphere 2.12 to 4.00D cylinder, per lens..........................	18.62
V2105	Spherocylinder, single vision, plano to plus or minus 4.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	29.39
V2106	Spherocylinder, single vision, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens..........................	31.14
V2107	Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, .12 to 2.00D cylinder, per lens..........................	21.89
V2108	Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 up to 4.00D cylinder, per lens..........................	22.18
V2109	Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	33.01
V2110	Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens..........................	37.34
V2111	Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens..........................	25.74
V2112	Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25D to 4.00D cylinder, per lens..........................	25.74
V2113	Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	37.40
V2114	Spherocylinder, single vision, sphere over plus or minus 12.00D, per lens..........................	29.90
V2115	Lenticular (myodisc), per lens, single vision..........................	77.05
V2116	Lenticular lens, nonaspheric, per lens, single vision..........................	51.17
V2117	Lenticular, aspheric, per lens, single vision..........................	57.00
V2410	Variable asphericity lens, single vision, full field, glass or plastic, per lens..........................	57.05
BIFOCAL GLASS OR PLASTIC
V2200	Sphere, bifocal, plano to plus or minus 4.00D, per lens..........................	$29.39
V2201	Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00D, per lens..........................	36.38
V2202	Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00D, per lens..........................	42.60
V2203	Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, .12 to 2.00D cylinder, per lens..........................	29.76
V2204	Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, 2.12 to 4.00D cylinder, per lens..........................	29.77
V2205	Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	43.91
V2206	Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens..........................	44.17
V2207	Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00D cylinder, per lens..........................	36.41
V2208	Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 to 4.00D cylinder, per lens..........................	38.48
V2209	Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	49.81
V2210	Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens..........................	51.64
V2211	Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens..........................	42.31
V2212	Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25 to 4.00D cylinder, per lens..........................	42.60
V2213	Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	52.37
V2214	Spherocylinder, bifocal, sphere over plus or minus 12.00D, per lens..........................	44.87
V2215	Lenticular, (myodisc), per lens, bifocal..........................	95.89
V2216	Lenticular, nonaspheric, per lens, bifocal..........................	87.40
V2217	Lenticular, aspheric lens, bifocal..........................	97.71
V2220	Bifocal add over 3.25D..........................	14.31
V2430	Variable asphericity lens, bifocal, full field, glass or plastic, per lens..........................	97.71
TRIFOCAL GLASS OR PLASTIC
V2300	Sphere, trifocal, plano to plus or minus 4.00D, per lens..........................	$ 42.35
V2301	Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00D, per lens..........................	46.42
V2302	Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00D, per lens..........................	54.33
V2303	Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, 12-2.00D cylinder, per lens..........................	42.59
V2304	Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, 2.25-4.00D cylinder, per lens..........................	50.21
V2305	Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, 4.25-6,00D cylinder, per lens..........................	55.10
V2306	Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens..........................	55.36
V2307	Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, .12 to 2.00D cylinder, per lens..........................	47.60
V2308	Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 to 4.00D cylinder, per lens..........................	47.60
V2309	Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	61.83
V2310	Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens..........................	62.09
V2311	Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens..........................	54.33
V2312	Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25 to 4.00D cylinder, per lens..........................	54.59
V2313	Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens..........................	62.09
V2314	Spherocylinder, trifocal, sphere over plus or minus 12.00D, per lens..........................	54.33
V2315	Lenticular (myodisc), per lens, trifocal..........................	By Report
V2316	Lenticular, nonaspheric lens, trifoca..........................l	By Report
V2317	Lenticular, aspheric lens, trifocal..........................	By Report
V2320	Trifocal add over 3.25D..........................	14.31
(2) Corneal Lenses
V2500	Contact lens, PMMA, spherical, per lens..........................	$ 65.94
V2501	Contact lens, PMMA, toric or prism ballast, per lens..........................	103.69
Z2900	Contact lens, PMMA or gas permeable, replacement, per lens..........................	71.32
V2510	Contact lens, gas permeable, spherical, per lens..........................	88.64
V2511	Contact lens, gas permeable, toric or prism ballast, per lens..........................	143.27
V2513	Contact lens, gas permeable, extended wear, per lens..........................	152.59
V2520	Contact lens, hydrophilic, spherical, per lens..........................	78.21
V2521	Contact lens, hydrophilic, toric or prism ballast, per lens..........................	136.15
Z2902	Contact lens, hydrophilic, replacement..........................	71.32
V2523	Contact lens, hydrophilic, extended wear, per lens..........................	112.92
Z2908	Contact lens, extended wear, replacemement..........................	97.59
Z2904	Thermal hydrophilic lens care kit..........................	37.59
Z2906	Bandage contact lenses..........................	56.77
(3) Miscellaneous Lens Items
V2700	Balance lens, per lens..........................	50 percent of of allowance for comparable single vision lens
V2710	Slab off prism, glass or plastic, per lens..........................	40.00
V2715	Prism, per lens..........................	8.17
V2718	Press-on lens, Fresnell prism, per lens..........................	15.78
V2740	Tint, plastic, rose 1 or 2, per lens..........................	By Report
V2741	Tint, plastic, other than rose 1 or 2, per lens..........................	By Report
V2742	Tint, glass, rose 1 or 2, per lens..........................	By Report
V2743	Tint, glass, other than rose 1 or 2, per lens..........................	By Report
V2744	Tint, photochromatic, per lens..........................	By Report
V2755	U-V lens, per lens..........................	By Report
(4) Frames
V2020	Frames, purchase..........................	21.31
Z2910	Arm with adjustable pad..........................	5.91
Z2912	Front--zyl (replace or repair)..........................	11.18
Z2914	Front--combination or metal (replace or repair)..........................	12.66
Z2916	Temple--all types (replace)..........................	6.70
(5) Low Vision Aids
V2600	Hand held low vision aids and other non-spectacle mounted aids..........................	By Report
V2610	Single lens spectacle mounted low vision aids..........................	By Report
V2615	Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system..........................	By Report
(6) Prosthetic Eyes
V2623	Prosthetic eye, plastic, custom..........................	By Report
V2624	Polishing and resurfacing of ocular prosthesis..........................	$31.96
V2625	Enlargement of ocular prosthesis..........................	By Report
V2626	Reduction of ocular prosthesis..........................	By Report
V2627	Scleral cover shell..........................	By Report
V2628	Fabrication and fitting of ocular conformer..........................	By Report
V2629	Prosthetic eye, other type..........................	By Report
(7) Miscellaneous Nonlens Items
Z2918	Occluder, clip patch style..........................	6.70
Z2920	Occluder, cup..........................	7.83
Z2926	Headband..........................	2.84
Z2928	Nosepads, nosepad covers, temple covers..........................	2.27
V2799	Not otherwise classified..........................	By Report

Notes

Cal. Code Regs. Tit. 22, § 51519

1. Amendment filed 11-28-88 as an emergency; operative 11-28-88 (Register 89, No. 11). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-28-89. For prior history, see Register 86, No. 46.
2. Certificate of Compliance as to 11-28-88 order transmitted to OAL 3-27-89 and filed 4-26-89 (Register 89, No. 18).
3. Repealer and new section filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsection (b)(6) filed 9-29-93 as an emergency; operative 9-29-93 (Register 93, No. 40). A Certificate of Compliance must be transmitted to OAL 1-27-94 or emergency language will be repealed by operation of law on the following day.
6. Editorial correction amending HISTORY 5 (Register 93, No. 46).
7. Certificate of Compliance as to 9-23-93 order transmitted to OAL 10-29-93 and filed 11-8-93 (Register 93, No. 46).
8. Amendment of subsections (b)(2) and (b)(6) filed 8-27-99 as an emergency; operative 8-30-99 (Register 99, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-28-99 or emergency language will be repealed by operation of law on the following day.
9. Amendment of subsections (b)(2) and (b)(6) refiled 12-27-99 as an emergency; operative 12-28-99 (Register 99, No. 53). A Certificate of Compliance must be transmitted to OAL by 4-26-2000 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsections (b)(2) and (b)(6) refiled 4-24-2000 as an emergency; operative 4-26-2000 (Register 2000, No. 17). A Certificate of Compliance must be transmitted to OAL by 8-24-2000 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 4-24-2000 order transmitted to OAL 5-24-2000 and filed 7-6-2000 (Register 2000, No. 27).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code; and Section 87, Chapter 1594, Statutes of 1982. Reference: Sections 14105 and 14105.3, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; and Statutes of 1985, Chapter 111, Items 4260-106-001 and 890.

1. Amendment filed 11-28-88 as an emergency; operative 11-28-88 (Register 89, No. 11). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-28-89. For prior history, see Register 86, No. 46.
2. Certificate of Compliance as to 11-28-88 order transmitted to OAL 3-27-89 and filed 4-26-89 (Register 89, No. 18).
3. Repealer and new section filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsection (b)(6) filed 9-29-93 as an emergency; operative 9-29-93 (Register 93, No. 40). A Certificate of Compliance must be transmitted to OAL 1-27-94 or emergency language will be repealed by operation of law on the following day.
6. Editorial correction amending History 5 (Register 93, No. 46).
7. Certificate of Compliance as to 9-23-93 order transmitted to OAL 10-29-93 and filed 11-8-93 (Register 93, No. 46).
8. Amendment of subsections (b)(2) and (b)(6) filed 8-27-99 as an emergency; operative 8-30-99 (Register 99, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-28-99 or emergency language will be repealed by operation of law on the following day.
9. Amendment of subsections (b)(2) and (b)(6) refiled 12-27-99 as an emergency; operative 12-28-99 (Register 99, No. 53). A Certificate of Compliance must be transmitted to OAL by 4-26-2000 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsections (b)(2) and (b)(6) refiled 4-24-2000 as an emergency; operative 4-26-2000 (Register 2000, No. 17). A Certificate of Compliance must be transmitted to OAL by 8-24-2000 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 4-24-2000 order transmitted to OAL 5-24-2000 and filed 7-6-2000 (Register 2000, No. 27).