Exams
Comprehensive check for vision problems and eye diseases
What is a routine eye exam?
Frame and lens frequency
What is 24 months?
Replacement modifier
What is RA?
Plan based on contracts with health care organizations to provide the vision care portion of the state's Medicaid program
What is VSP Medicaid?
Amount patient pays for $39 retinal screening when the plan states, "Charge lesser of $39 or U&C"
What is $39?
The date the office performed the patient's eye exam
What is the exam date of service?
Single vision lenses must have ±0.75D in at least one meridian of either eye
What is a minimum Rx?
This is required when reporting diabetes on an exam claim
What is a CPT II Code?
Submission within 180 days of DOS
What is timely filing?
Process of obtaining an authorization for an earlier date of service
What is backdating?
DAILY DOUBLE:
Medicaid exam frequency
What is 24 months?
Replacement of lost, stolen, broken, or damaged eyeglasses before eligibility date
What are Repair and Replace benefits?
92340, 92341, 92342, 92352, 92353
What are dispensing codes?
True or False: All VSP in-network locations & doctors are enrolled with VSP Medicaid
False
Eyefinity
What is the VSP billing portal?
Reporting this for a health condition may result in an additional $5 payment from VSP
What is a CPT II code?
Material item type that is not typically covered
What are contact lenses?
Do not bill VSP for _______ services or materials
What is non-covered?
Plan that completely covers the patient's contacts & fitting with one copay
What is the Covered Contact Lens plan?
VSP's name for the authorization page that lists available services and all the copays
What is the Patient Record Report/Form?
Non-covered exam service related to a non-covered material (for Medicaid)
What is a contact lens fitting?
PIA
What is the acronym for Prison Industry Authority?
Modifier indicating specific documentation is on file
What is KX?
Plan covering medical & urgent eye care services
What is VSP Essential Medical Eye Care?
One-time copay type that is applied once per service frequency to exam or materials.
What is a total copay?