S0514 Color Contact Lens HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II S0514: Color Contact Lens, Per Lens

HCPCS Level II code S0514 denotes a color contact lens, billed per lens. This supply code is used when a colored corrective or cosmetic contact lens is furnished and billed separately from professional services. Nationally, supply codes for contact lenses are relevant for outpatient ophthalmology, optometry, and optical retail settings where lenses are dispensed or replaced. Coverage and payment for colored contact lenses can vary across commercial payers and Medicare, and such codes affect billing workflows, patient cost-sharing, and supplier documentation.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical and billing context, payer coverage considerations, common modifiers associated with supply billing (listed in the metadata), and areas where policy updates or payer-specific rules commonly affect reimbursement and claim adjudication. The report summarizes payment benchmarks and typical sites of service and highlights practical billing considerations for outpatient clinics and optical dispensers.

Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareS0514HCPCS Level IIcontact lensophthalmologyoptometrymedical supplyoutpatientbillingsupply code

Billing Code Overview

HCPCS Level II code S0514 describes a color contact lens, billed per lens. This code represents supply of a colored corrective or cosmetic contact lens provided to a patient.

Service type: Medical supply — contact lens
Typical site of service: Outpatient clinic, ophthalmology or optometry practice, retail optical dispenser

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 22-year-old patient presents to an ophthalmology or optometry clinic requesting decorative color contact lenses for cosmetic use or to correct a refractive error with a tinted lens. The clinical workflow begins with a patient history and refractive assessment, including visual acuity, refraction, and slit-lamp anterior segment exam to assess corneal health, tear film, and eyelid function. A contact lens fitting is performed when lenses are to be worn; this may include corneal topography or keratometry for specialty fits. The provider documents lens power, base curve, diameter, and color/style. A written prescription for the color contact lens S0514 (color contact lens, per lens) is issued when indicated. Education on insertion, removal, hygiene, and wear schedule is provided. Follow-up visits are scheduled to assess fit, comfort, visual acuity, and ocular surface integrity. Typical sites of service are ophthalmology or optometry offices, optical shops affiliated with licensed eye care providers, and ambulatory surgical centers only if lenses are part of a procedure (rare). Payers involved may include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA plans, and Medicare where allowed by coverage policy; coverage for decorative lenses is frequently limited and subject to medical necessity rules and state-specific regulations.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting

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HCPCS-S0316-DISEASE-MANAGEMENT-FOLLOW-UP-REASSESSMENT

HCPCS S0316: Disease Management Program Follow-Up/Reassessment

HCPCS-S0190-MIFEPRISTONE-ORAL-200MG

HCPCS S0190: Mifepristone, Oral, 200 mg

HCPCS-S8999-RESUSCITATION-BAG-EMERGENCY-VENTILATION-SUPPORT

HCPCS S8999: Resuscitation Bag for Emergency Ventilation

HCPCS-S5120-CHORE-SERVICES-15-MINUTE

HCPCS S5120: Chore Services, per 15 minutes

HCPCS-S8451-PREFABRICATED-WRIST-ANKLE-SPLINT

HCPCS S8451: Prefabricated Wrist or Ankle Splint

HCPCS-S8423-CUSTOM-HEAVY-WEIGHT-GRADIENT-PRESSURE-SLEEVE

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HCPCS-S2206-MINIMALLY-INVASIVE-DIRECT-CORONARY-BYPASS-TWO-ARTERIAL-GRAFTS

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HCPCS-S9129-OCCUPATIONAL-THERAPY-HOME-PER-DIEM

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HCPCS-S3850-GENETIC-TESTING-SICKLE-CELL-ANEMIA

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Taxonomy Code	Specialty	Notes
`207K00000X`	Ophthalmology	Medical and surgical eye care providers who evaluate and prescribe contact lenses and perform related procedures.
`207P00000X`	Optometry	Primary providers for contact lens fitting, prescribing, and routine follow-up in ambulatory settings.
`363L00000X`	Optician	Licensed professionals who dispense and fit contact lenses and glasses under prescription.
`208400000X`	Ophthalmic Plastic and Reconstructive Surgery	Specialists involved if lenses are part of complex ocular surface or reconstructive procedures.
`193200000X`	Vision Care Provider	Broad taxonomy used by clinics providing comprehensive vision services including contact lens dispensing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H52.4`	Presbyopia	Common refractive condition for which corrective contact lenses, including colored lenses with prescription power, may be prescribed.
`H52.1`	Myopia (near-sightedness)	A frequent indication for prescription contact lenses; color lenses may be manufactured to required power.
`H52.2`	Hypermetropia (far-sightedness)	Another common refractive indication for contact lens prescription.
`H57.8`	Other specified disorders of eye and adnexa	Used when non-specific ocular complaints prompt lens fitting or when lenses are supplied for symptomatic relief.
`H16.9`	Keratitis, unspecified	May be relevant when therapeutic lens use is indicated; lenses are typically contraindicated until resolved but relevant for documentation.
`Z01.00`	Encounter for examination of eyes and vision without abnormal findings	Often used for routine contact lens examinations and fitting encounters.
`Z01.01`	Encounter for examination of eyes and vision with abnormal findings	Used when an examination for contact lens fitting reveals abnormalities needing documentation.
`H04.129`	Disorder of lacrimal system, unspecified	Disorders affecting tear film that impact contact lens tolerance and fitting considerations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`92004`	Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; new patient, comprehensive, one or more visits	Often performed prior to lens prescription for a new patient evaluation when contact lenses are first prescribed.
`92014`	Ophthalmological services: intermediate or complete ophthalmological services; established patient, comprehensive, one or more visits	Used for follow-up assessments to evaluate fit and ocular health after dispensing color contact lenses.
`92083`	Extended ophthalmoscopy or ocular surface photography (corneal topography, not exact code — corneal topography often reported with `92250` for fundus photography and other codes)	Ancillary corneal mapping or topography services used when specialty lens fitting requires corneal measurements.
`92310`	Fitting of contact lens for correction of keratoconus, rigid gas permeable lens, with medical supervision	Related specialized fitting codes when a therapeutic or specialty lens fitting is required alongside cosmetic lenses.
`99070`	Supplies and materials (except spectacles), provided by the physician, over and above those usually included with the office visit	Used when billing for supplies or materials associated with lens dispensing; payers often restrict billing of lenses under this code.

Note: If specific CPT codes are required by payer policy for lens fitting or diagnostic testing, providers select the appropriate ophthalmic evaluation, fitting, or diagnostic CPT codes in sequence with S0514 as allowed by coverage rules.

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