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Vision Services Coverage for High Index Lenses
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This policy governs Alaska Medicaid coverage and service authorization requirements for high index eyeglass lenses and instructions for providers requesting authorization through the vision contractor. It affects providers ordering high index lenses for Alaska Medicaid members.
All providers must use HCPCS codes V2782 or V2783 when requesting a service authorization for high index lenses effective 9/1/2022.
Coverage Criteria for High Index Lenses
High index lens coverage criteria
Covered when ALL of the following criteria are met:
ALL of the following
- Correction in either eye is +/- 6.75 diopters or greater (sphere only or a combination of sphere and cylinder powers).
Diopter threshold applies to either eye; sphere alone or sphere plus cylinder combinations qualify.
- A service authorization is obtained prior to placing an order through the vision contractor (Classic Optical).
Authorization required before ordering high index lenses.
Submission requirements
- Box 16 of the Vision Service Authorization Request form contains the member's eyeglass prescription and diagnosis.
- Box 18 uses RT and/or LT modifiers for HCPCS codes; bilateral items must be submitted on two separate lines with RT and LT modifiers and 1 unit on each line.
- Box 20 contains the total units (1 unit = 1 lens).
Unit counting: enter total units and remember 1 unit equals one lens.
- Fax the completed form and any supporting documentation to the Conduent SA unit at 907.644.8131.
HCPCS Codes and Diopter Thresholds
Service Authorization and Submission Requirements
How to Submit Service Authorization
Complete the Vision Service Authorization Request form and include all required information: enter the member's eyeglass prescription and diagnosis in Box 16; enter the relevant high index lens HCPCS code (V2782 or V2783) in Box 17; use RT and/or LT modifiers in Box 18 for all HCPCS codes (for bilateral items, list each item on separate lines with RT and LT and 1 unit per line); enter total units in Box 20 (1 unit = one lens). Fax the completed form and supporting documentation to the Conduent SA unit at 907.644.8131.
Definitions and Modifier Use
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