Cal. Code Regs. Tit. 22, § 51519.2 - Reimbursement Rates for Ophthalmic Appliances Supplied by a Fabricating Optical Laboratory Under an Exclusive Area Negotiated Contract
(a) General Provisions.
(1) Reimbursement rates listed in (b) below
include lens grinding, cutting, edging, impact resistance and testing, oversize
lenses, special beveling, drilling and mounting.
(2) "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.
(b) Maximum
reimbursement rates payable under an exclusive area negotiated contract for eye
appliances shall be as follows:
(1) Spectacle
Lenses.
Procedure Code |
Maximum Reimbursement Rates per Lens |
|
SINGLE VISION GLASS |
||
Z3100 | 0.00-4.00 diopters.......................... | ..........................$ 7.34 |
Z3102 | 4.12-7.00 diopters.......................... | ..........................7.68 |
Z3104 | 7.12-20.00 diopters.......................... | ..........................19.79 |
Z3106 | Lenticular.......................... | ..........................28.44 |
BIFOCAL GLASS |
||
Z3108 | 0.00-4.00 diopters.......................... | ..........................$10.95 |
Z3110 | 4.12-7.00 diopters.......................... | ..........................12.60 |
Z3112 | 7.12-20.00 diopters.......................... | ..........................21.60 |
Z3114 | Lenticular.......................... | ..........................40.14 |
TRIFOCAL GLASS |
||
Z3116 | 0.00-4.00 diopters.......................... | ..........................$15.65 |
Z3118 | 4.12-7.00 diopters.......................... | ..........................16.94 |
SINGLE VISION PLASTIC |
||
Z3120 | 0.00-4.00 diopters.......................... | ..........................$8.32 |
Z3122 | 4.12-6.00 diopters.......................... | ..........................9.56 |
Z3124 | 6.12-10.00 diopters.......................... | ..........................12.43 |
Z3126 | 10.12-14.00 diopters.......................... | ..........................15.00 |
Z3128 | 14.12-18.00 diopters.......................... | ..........................15.00 |
Z3130 | Aspheric (lenticular or full field).......................... | ..........................28.60 |
Z3132 | Lenticular, nonaspheric, plus.......................... | ..........................26.65 |
Z3134 | Lenticular, nonaspheric, minus.......................... | ..........................32.30 |
BIFOCAL PLASTIC |
||
Z3136 | 0.00-4.00 diopters.......................... | ..........................$13.04 |
Z3138 | 4.12-6.00 diopters.......................... | ..........................15.32 |
Z3140 | 6.12-10.00 diopters.......................... | ..........................18.01 |
Z3142 | 10.12-14.00 diopters.......................... | ..........................28.92 |
Z3144 | 14.12-18.00 diopters.......................... | ..........................28.92 |
Z3146 | Aspheric (lenticular or full field).......................... | ..........................46.15 |
Z3148 | Lenticular, nonaspheric, plus.......................... | ..........................31.20 |
Z3150 | Lenticular, nonaspheric, minus.......................... | ..........................35.42 |
TRIFOCAL PLASTIC |
||
Z3152 | 0.00-4.00 diopters.......................... | ..........................$20.15 |
Z3154 | 4.12-7.75 diopters.......................... | ..........................22.17 |
Z3156 | 8.00-14.00 diopters.......................... | ..........................32.18 |
(2) Miscellaneous Lens Items.
Z3158 | Balance lens.......................... | 50 percent of allowance for comparable single vision lens |
Z3160 | 4.00-6.00 diopter, cylinder.......................... | ..........................$1.81 |
Z3162 | Prism (if available from stock blank).......................... | ..........................4.22 |
Z3164 | Bifocal--adds 4.00 diopter or higher.......................... | ..........................13.00 |
Z3166 | Absorptive characteristics.......................... | ..........................By Report |
Z3168 | Higher powers than listed (per diopter).......................... | ..........................2.48 |
Z3170 | Slab-off.......................... | ..........................26.00 |
Z3172 | Fresnel prism.......................... | ..........................11.05 |
(3) Frames.
Z3174 | Frame--zyl.......................... | ..........................$9.50 |
Z3176 | Frame--(metal only).......................... | ..........................16.20 |
Z3178 | Arm with adjustable pad.......................... | ..........................3.75 |
Z3180 | Front--zyl (replace supplied frames).......................... | ..........................4.80 |
Z3182 | Front--metal only (replace supplied frames).......................... | ..........................10.40 |
Z3184 | Temple--(replace supplied frames).......................... | ..........................2.35 |
Notes
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. Amendment of section heading and subsections (b)(1)-(b)(3) 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 including amendment of subsection (b)(3) transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsections (a) and (b) and new NOTE filed 10-1-92 with Secretary of State by Department of Health Services; operative 10-1-92. Submitted to OAL for printing only pursuant to section 147(c), SB 485, (Chapter 722, Statutes of 1992) (Register 92, No. 40).
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code; and Section 87, Chapter 1594, Statutes of 1982. Reference: Sections 14105.3 and 14132, Welfare and Institutions Code.
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. Amendment of section heading and subsections (b)(1)-(b)(3) 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 including amendment of subsection (b)(3) transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsections (a) and (b) and new Note filed 10-1-92 with Secretary of State by Department of Health Services; operative 10-1-92. Submitted to OAL for printing only pursuant to section 147(c), SB 485, (Chapter 722, Statutes of 1992) (Register 92, No. 40).
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