| University Physicians Healthcare Group | ||||
| Rates Effective 5/1/2004 - Vision & Hearing (Use Ctrl + F to search) | ||||
| CPT codes, descriptors and other data only are copyright 2004 American Medical Association. All Rights Reserved. | ||||
| PROC | DESCRIPTION | NON FAC RATE 2004 | FAC RATE 2004 | |
| 92002 | OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATI | $68.73 | $46.45 | |
| 92004 | OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION WITH INITIATI | $125.33 | $88.81 | |
| 92012 | OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIAT | $62.67 | $36.01 | |
| 92014 | OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, WITH INITIAT | $92.28 | $58.68 | |
| 92015 | DETERMINATION OF REFRACTIVE STATE | $69.00 | $20.07 | |
| 92018 | OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH | $134.41 | $134.41 | |
| 92019 | OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH | $70.99 | $70.99 | |
| 92020 | GONIOSCOPY (SEPARATE PROCEDURE) | $26.27 | $20.06 | |
| 92060 | SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG | $52.87 | $52.87 | |
| 92065 | ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH CONTINUING MEDICAL DIRECTION AND E | $34.35 | $34.35 | |
| 92070 | FITTING OF CONTACT LENS FOR TREATMENT OF DISEASE, INCLUDING SUPPLY OF LENS | $65.98 | $38.23 | |
| 92081 | VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND | $45.29 | $45.29 | |
| 92082 | VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH MEDICAL DIAGNOSTIC | $59.24 | $59.24 | |
| 92083 | VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH MEDICAL DIAGNOSTIC | $68.05 | $68.05 | |
| 92100 | SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH MULTIPLE MEASUREMENTS OF INTRAOC | $81.17 | $48.68 | |
| 92120 | TONOGRAPHY WITH INTERPRETATION AND REPORT, RECORDING INDENTATION TONOMETER | $69.03 | $42.74 | |
| 92130 | TONOGRAPHY WITH WATER PROVOCATION | $75.97 | $44.57 | |
| 92135 | SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING (EG, SCANNING LASER) WI | $42.36 | $42.36 | |
| 92136 | OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH INTRAOCULAR LE | $87.32 | $87.32 | |
| 92140 | PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION AND REPORT, WITHOUT TON | $53.40 | $26.74 | |
| 92225 | OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, | $22.63 | $20.44 | |
| 92226 | OPHTHALMOSCOPY, EXTENDED AS FOR RETINAL DETACHMENT (MAY INCLUDE USE OF CONT | $20.40 | $18.21 | |
| 92230 | FLUORESCEIN ANGIOSCOPY WITH INTERPRETATION AND REPORT | $84.20 | $30.52 | |
| 92235 | FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION A | $140.49 | $140.49 | |
| 92240 | INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) W/INTERPRETATIO | $301.03 | $301.03 | |
| 92250 | FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT | $80.42 | $80.42 | |
| 92260 | OPHTHALMOSCOPY, WITH MEDICAL DIAGNOSTIC EVALUATION; WITH OPHTHALMODYNAMOMET | $18.46 | $11.16 | |
| 92265 | NEEDLE OCULOELECTROMYOGRAPHY, ONE OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH | $100.52 | $100.52 | |
| 92270 | ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORT | $89.65 | $89.65 | |
| 92275 | ELECTRORETINOGRAPHY WITH INTERPRETATION AND REPORT | $109.81 | $109.81 | |
| 92283 | COLOR VISION EXAMINATION, EXTENDED, EG, ANOMALOSCOPE OR EQUIVALENT | $37.47 | $37.47 | |
| 92284 | DARK ADAPTATION EXAMINATION WITH INTERPRETATION AND REPORT | $94.13 | $94.13 | |
| 92285 | EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATIO | $47.35 | $47.35 | |
| 92286 | SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH S | $148.92 | $148.92 | |
| 92287 | SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH MEDICAL DIAGNOSTIC EVALUATION; WI | $129.29 | $42.38 | |
| 92310 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONT | $86.21 | $61.74 | |
| 92311 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONT | $85.04 | $54.73 | |
| 92312 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONT | $91.03 | $66.57 | |
| 92313 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONT | $77.52 | $45.75 | |
| 92314 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH | $60.49 | $36.03 | |
| 92315 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH | $51.90 | $23.05 | |
| 92316 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH | $62.31 | $36.75 | |
| 92317 | PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH | $55.55 | $22.69 | |
| 92325 | MODIFICATION OF CONTACT LENS (SEPARATE PROCEDURE), WITH MEDICAL SUPERVISION | $14.65 | $14.65 | |
| 92326 | REPLACEMENT OF CONTACT LENS | $62.33 | $62.33 | |
| 92330 | PRESCRIPTION, FITTING, AND SUPPLY OF OCULAR PROSTHESIS (ARTIFICIAL EYE), WI | $81.80 | $54.41 | |
| 92335 | PRESCRIPTION OF OCULAR PROSTHESIS (ARTIFICIAL EYE) AND DIRECTION OF FITTING | $54.09 | $23.42 | |
| 92340 | FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MONOFOCAL | $39.78 | $19.33 | |
| 92341 | FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; BIFOCAL | $44.98 | $24.53 | |
| 92342 | FITTING OF SPECTACLES, EXCEPT FOR APHAKIA; MULTIFOCAL, OTHER THAN BIFOCAL | $47.95 | $27.86 | |
| 92352 | FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MONOFOCAL | $40.88 | $19.33 | |
| 92353 | FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MULTIFOCAL | $47.97 | $26.42 | |
| 92354 | FITTING OF SPECTACLE MOUNTED LOW VISION AID; SINGLE ELEMENT SYSTEM | $328.70 | $328.70 | |
| 92355 | FITTING OF SPECTACLE MOUNTED LOW VISION AID; TELESCOPIC OR OTHER COMPOUND L | $158.89 | $158.89 | |
| 92358 | PROSTHESIS SERVICE FOR APHAKIA, TEMPORARY (DISPOSABLE OR LOAN, INCLUDING MA | $37.46 | $37.46 | |
| 92370 | REPAIR AND REFITTING SPECTACLES; EXCEPT FOR APHAKIA | $32.85 | $17.51 | |
| 92371 | REPAIR AND REFITTING SPECTACLES; SPECTACLE PROSTHESIS FOR APHAKIA | $23.45 | $23.45 | |
| 92390 | SUPPLY OF SPECTACLES, EXCEPT PROSTHESIS FOR APHAKIA AND LOW VISION AIDS | BR | BR | |
| 92391 | SUPPLY OF CONTACT LENSES, EXCEPT PROSTHESIS FOR APHAKIA | BR | BR | |
| 92393 | SUPPLY OF OCULAR PROSTHESIS (ARTIFICIAL EYE) | $452.63 | $452.63 | |
| 92395 | SUPPLY OF PERMANENT PROSTHESIS FOR APHAKIA; SPECTACLES | $50.81 | $50.81 | |
| 92499 | UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE | BR | BR | |
| 92502 | OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA | $100.49 | $100.49 | |
| 92504 | BINOCULAR MICROSCOPY (SEPARATE DIAGNOSTIC PROCEDURE) | $25.02 | $10.41 | |
| 92506 | EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AUDITORY PROCESSING, | $60.06 | $22.62 | |
| 92507 | TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR AUDITORY PROCE | $37.10 | $17.49 | |
| 92510 | AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT (INCLUDES EVALUATION OF AUR | $134.81 | $88.80 | |
| 92511 | NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE PROCEDURE) | $147.65 | $61.84 | |
| 92512 | NASAL FUNCTION STUDIES, EG, RHINOMANOMETRY | $60.79 | $27.92 | |
| 92516 | FACIAL NERVE FUNCTION STUDIES (EG, ELECTRONEURONOGRAPHY) | $49.37 | $24.90 | |
| 92520 | LARYNGEAL FUNCTION STUDIES | $48.26 | $43.88 | |
| 92526 | TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING | $81.97 | $28.65 | |
| 92531 | SPONTANEOUS NYSTAGMUS, INCLUDING GAZE | $16.30 | $16.30 | |
| 92532 | POSITIONAL NYSTAGMUS TEST | $20.00 | $20.00 | |
| 92533 | CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION C | $13.23 | $13.23 | |
| 92534 | OPTOKINETIC NYSTAGMUS TEST | $61.80 | $61.80 | |
| 92541 | SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION NYSTAGMUS, WITH REC | $51.98 | $51.98 | |
| 92542 | POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING | $52.25 | $52.25 | |
| 92543 | CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION C | $23.90 | $23.90 | |
| 92544 | OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION | $41.60 | $41.60 | |
| 92545 | OSCILLATING TRACKING TEST, WITH RECORDING | $38.66 | $38.66 | |
| 92546 | SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING | $77.78 | $77.78 | |
| 92547 | USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY | $44.44 | $44.44 | |
| 92548 | COMPUTERIZED DYNAMIC POSTUROGRAPHY | $141.26 | $141.26 | |
| 92551 | SCREENING TEST, PURE TONE, AIR ONLY | $15.87 | $15.87 | |
| 92552 | PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY | $17.69 | $17.69 | |
| 92553 | PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE | $26.54 | $26.54 | |
| 92555 | SPEECH AUDIOMETRY THRESHOLD; | $15.14 | $15.14 | |
| 92556 | SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION | $23.26 | $23.26 | |
| 92557 | COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 | $48.34 | $48.34 | |
| 92560 | BEKESY AUDIOMETRY; SCREENING | $23.81 | $23.81 | |
| 92561 | BEKESY AUDIOMETRY; DIAGNOSTIC | $28.73 | $28.73 | |
| 92562 | LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL | $16.23 | $16.23 | |
| 92563 | TONE DECAY TEST | $15.14 | $15.14 | |
| 92564 | SHORT INCREMENT SENSITIVITY INDEX (SISI) | $19.20 | $19.20 | |
| 92565 | STENGER TEST, PURE TONE | $15.87 | $15.87 | |
| 92567 | TYMPANOMETRY (IMPEDANCE TESTING) | $21.43 | $21.43 | |
| 92568 | ACOUSTIC REFLEX TESTING | $15.14 | $15.14 | |
| 92569 | ACOUSTIC REFLEX DECAY TEST | $16.23 | $16.23 | |
| 92571 | FILTERED SPEECH TEST | $15.50 | $15.50 | |
| 92572 | STAGGERED SPONDAIC WORD TEST | $3.69 | $3.69 | |
| 92573 | LOMBARD TEST | $14.41 | $14.41 | |
| 92575 | SENSORINEURAL ACUITY LEVEL TEST | $11.77 | $11.77 | |
| 92576 | SYNTHETIC SENTENCE IDENTIFICATION TEST | $18.10 | $18.10 | |
| 92577 | STENGER TEST, SPEECH | $29.14 | $29.14 | |
| 92579 | VISUAL REINFORCEMENT AUDIOMETRY (VRA) | $29.10 | $29.10 | |
| 92582 | CONDITIONING PLAY AUDIOMETRY | $29.10 | $29.10 | |
| 92583 | select PICTURE AUDIOMETRY | $35.76 | $35.76 | |
| 92584 | ELECTROCOCHLEOGRAPHY | $99.47 | $99.47 | |
| 92585 | AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF | $101.13 | $101.13 | |
| 92586 | AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF | $73.62 | $73.62 | |
| 92587 | EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSI | $60.13 | $60.13 | |
| 92588 | EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPA | $79.03 | $79.03 | |
| 92589 | CENTRAL AUDITORY FUNCTION TEST(S) (SPECIFY) | $21.80 | $21.80 | |
| 92590 | HEARING AID EXAMINATION AND SELECTION; MONAURAL | $52.90 | $52.90 | |
| 92591 | HEARING AID EXAMINATION AND SELECTION; BINAURAL | $84.64 | $84.64 | |
| 92592 | HEARING AID CHECK; MONAURAL | $9.52 | $9.52 | |
| 92593 | HEARING AID CHECK; BINAURAL | $19.04 | $19.04 | |
| 92594 | ELECTROACOUSTIC EVALUATION FOR HEARING AID; MONAURAL | BR | BR | |
| 92595 | ELECTROACOUSTIC EVALUATION FOR HEARING AID; BINAURAL | BR | BR | |
| 92596 | EAR PROTECTOR ATTENUATION MEASUREMENTS | $23.99 | $23.99 | |
| 92597 | EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC DEVICE TO SUPPLEMENT | $95.86 | $50.58 | |
| 92601 | DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; WITH | $127.37 | $127.37 | |
| 92602 | DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; SUBS | $89.03 | $89.03 | |
| 92603 | DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; WITH PROGRAM | $84.28 | $84.28 | |
| 92604 | DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; SUBSEQUENT R | $56.53 | $56.53 | |
| 92605 | EVALUATION FOR PRESCRIPTION OF NON-SPEECH-GENERATING AUGMENTATIVE AND ALTER | BR | BR | |
| 92606 | THERAPEUTIC SERVICE(S) FOR THE USE OF NON-SPEECH-GENERATING DEVICE, INCLUDI | BR | BR | |
| 92607 | EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNAT | $119.62 | $119.62 | |
| 92608 | EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNAT | $26.50 | $26.50 | |
| 92609 | THERAPEUTIC SERVICES FOR THE USE OF SPEECH-GENERATING DEVICE, INCLUDING PRO | $60.05 | $60.05 | |
| 92610 | EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION | $128.87 | $128.87 | |
| 92611 | MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECO | $128.87 | $128.87 | |
| 92612 | FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RE | $149.63 | $75.14 | |
| 92613 | FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RE | $42.79 | $42.79 | |
| 92614 | FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CIN | $138.68 | $72.95 | |
| 92615 | FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CIN | $38.70 | $38.70 | |
| 92616 | FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSO | $193.59 | $108.87 | |
| 92617 | FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSO | $47.60 | $47.60 | |
| 92700 | UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE | BR | BR | |
| Q1001 | NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 1 AS DEFINED IN FEDERAL REGISTER N | BR | BR | |
| Q1002 | NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 2 AS DEFINED IN FEDERAL REGISTER N | BR | BR | |
| Q1003 | NEW TECHNOLOGY INTRAOCULAR LENSE CATEGORY 3 AS DEFINED IN FEDERAL REGISTER | BR | BR | |
| Q1004 | NEW TECHNOLOGY INTRAOCULAR LENSE CATEGORY 4 AS DEFINED IN FEDERAL REGISTER | BR | BR | |
| Q1005 | NEW TECHNOLOGY INTRAOCULAR LENSE CATEGORY 5 AS DEFINED IN FEDERAL REGISTER | BR | BR | |
| V2020 | FRAMES, PURCHASES | $67.05 | $67.05 | |
| V2100 | SPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00, PER LENS | $31.41 | $31.41 | |
| V2101 | SPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS | $42.10 | $42.10 | |
| V2102 | SPHERE, SINGLE VISION, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LEN | $51.06 | $51.06 | |
| V2103 | SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO | $29.99 | $29.99 | |
| V2104 | SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO | $31.73 | $31.73 | |
| V2105 | SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO | $34.80 | $34.80 | |
| V2106 | SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6. | $41.65 | $41.65 | |
| V2107 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00 SPH | $44.81 | $44.81 | |
| V2108 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D S | $42.61 | $42.61 | |
| V2109 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SP | $47.88 | $47.88 | |
| V2110 | SPEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO 7.00D SPHERE, OVER 6.00 | $41.01 | $41.01 | |
| V2111 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D S | $48.35 | $48.35 | |
| V2112 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D S | $50.73 | $50.73 | |
| V2113 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D S | $50.32 | $50.32 | |
| V2114 | SPHEROCYLINDER, SINGLE VISION, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS | $54.51 | $54.51 | |
| V2115 | LENTICULAR, (MYODISC), PER LENS, SINGLE VISION | $75.95 | $75.95 | |
| V2118 | ANISEIKONIC LENS, SINGLE VISION | $75.83 | $75.83 | |
| V2121 | LENTICULAR LENS, PER LENS, SINGLE | $80.96 | $80.96 | |
| V2199 | NOT OTHERWISE CLASSIFIED, SINGLE VISION LENS | BR | BR | |
| V2200 | SPHERE, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS | $46.95 | $46.95 | |
| V2201 | SPHERE, BIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS | $57.14 | $57.14 | |
| V2202 | SPHERE, BIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D,PER LENS | $52.73 | $52.73 | |
| V2203 | SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO 2.00D | $51.06 | $51.06 | |
| V2204 | SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D | $51.82 | $51.82 | |
| V2205 | SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D | $51.18 | $51.18 | |
| V2206 | SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D CY | $57.49 | $57.49 | |
| V2207 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE,. | $55.83 | $55.83 | |
| V2208 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, | $61.50 | $61.50 | |
| V2209 | SPHEROCYLINDER,BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4 | $57.70 | $57.70 | |
| V2210 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, | $61.54 | $61.54 | |
| V2211 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, | $74.75 | $74.75 | |
| V2212 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, | $70.16 | $70.16 | |
| V2213 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, | $65.35 | $65.35 | |
| V2214 | SPHEROCYLINDER, BIFOCAL, SPHERE OVER PLUS OR MINUS 12.00D, PER LENS | $73.91 | $73.91 | |
| V2215 | LENTICULAR (MYODISC), PER LENS, BIFOCAL | $90.89 | $90.89 | |
| V2218 | ANISEIKONIC, PER LENS, BIFOCAL | $87.26 | $87.26 | |
| V2219 | BIFOCAL SEG WIDTH OVER 28MM | $35.71 | $35.71 | |
| V2220 | BIFOCAL ADD OVER 3.25D | $33.75 | $33.75 | |
| V2221 | LENTICULAR LENS, PER LENS, BIFOCAL | $94.45 | $94.45 | |
| V2299 | SPECIALTY BIFOCAL (BY REPORT) | BR | BR | |
| V2300 | SPHERE, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00.D, PER LENS | $58.10 | $58.10 | |
| V2301 | SPHERE, TRIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D PER LENS | $71.51 | $71.51 | |
| V2302 | SPHERE, TRIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00, PER LENS | $65.76 | $65.76 | |
| V2303 | SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12-2.00D C | $62.65 | $62.65 | |
| V2304 | SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.25-4.00D C | $65.01 | $65.01 | |
| V2305 | SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00 | $65.19 | $65.19 | |
| V2306 | SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D C | $65.73 | $65.73 | |
| V2307 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, | $70.40 | $70.40 | |
| V2308 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, | $68.68 | $68.68 | |
| V2309 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, | $83.14 | $83.14 | |
| V2310 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, | $70.23 | $70.23 | |
| V2311 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE | $85.98 | $85.98 | |
| V2312 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE | $95.82 | $95.82 | |
| V2313 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE | $107.01 | $107.01 | |
| V2314 | SPHEROCYLINDER, TRIFOCAL, SPHERE OVER PLUS OR MINUS 12 .00D, PER LENS | $99.33 | $99.33 | |
| V2315 | LENTICULAR, (MYODISC), PER LENS, TRIFOCAL | $123.23 | $123.23 | |
| V2318 | ANISEIKONIC LENS, TRIFOCAL | $156.85 | $156.85 | |
| V2319 | TRIFOCAL SEG WIDTH OVER 28 MM | $39.82 | $39.82 | |
| V2320 | TRIFOCAL ADD OVER 3.25D | $42.02 | $42.02 | |
| V2321 | LENTICULAR LENS, PER LENS, TRIFOCAL | $116.92 | $116.92 | |
| V2399 | SPECIALTY TRIFOCAL (BY REPORT) | BR | BR | |
| V2410 | VARIABLE ASPHERICITY LENS, SINGLE VISION, FULL FIELD, GLASS OR PLASTIC, PER | $95.88 | $95.88 | |
| V2430 | VARIABLE ASPHERICITY LENS, BIFOCAL, FULL FIELD, GLASS OR PLASTIC, PER LENS | $115.55 | $115.55 | |
| V2499 | VARIABLE SPHERICITY LENS, OTHER TYPE | BR | BR | |
| V2500 | CONTACT LENS, PMMA, SPHERICAL, PER LENS | $70.52 | $70.52 | |
| V2501 | CONTACT LENS, PMMA, TORIC OR PRISM BALLAST, PER LENS | $110.91 | $110.91 | |
| V2502 | CONTACT LENS PMMA, BIFOCAL, PER LENS | $162.28 | $162.28 | |
| V2503 | CONTACT LENS PMMA, COLOR VISION DEFICIENCY, PER LENS | $112.65 | $112.65 | |
| V2510 | CONTACT LENS, GAS PERMEABLE, SPHERICAL, PER LENS | $94.80 | $94.80 | |
| V2511 | CONTACT LENS, GAS PERMEABLE, TORIC, PRISM BALLAST, PER LENS | $153.22 | $153.22 | |
| V2512 | CONTACT LENS, GAS PERMEABLE, BIFOCAL,PER LENS | $177.88 | $177.88 | |
| V2513 | CONTACT LENS, GAS PERMEABLE, EXTENDED WEAR, PER LENS | $163.20 | $163.20 | |
| V2520 | CONTACT LENS HYDROPHILIC, SPHERICAL, PER LENS | $83.64 | $83.64 | |
| V2521 | CONTACT LENS HYDROPHILIC, TORIC, OR PRISM BALLAST, PER LENS | $145.61 | $145.61 | |
| V2522 | CONTACT LENS HYDROPHILLIC, BIFOCAL, PER LENS | $188.95 | $188.95 | |
| V2523 | CONTACT LENS HYDROPHILIC, EXTENDED WEAR, PER LENS | $120.76 | $120.76 | |
| V2530 | CONTACT LENS, SCLERAL, GAS IMPERMEABLE, PER LENS (FOR CONTACT LENS MODIFICA | $178.86 | $178.86 | |
| V2531 | CONTACT LENS, SCLERAL, GAS PERMEABLE, PER LENS (FOR CONTACT LENS MODIFICATI | $426.30 | $426.30 | |
| V2599 | CONTACT LENS, OTHER TYPE | BR | BR | |
| V2600 | HAND HELD LOW VISION AIDS AND OTHER NONSPECTACLE MOUNTED AIDS | BR | BR | |
| V2610 | SINGLE LENS SPECTACLE MOUNTED LOW VISION AIDS | BR | BR | |
| V2615 | TELESCOPIC AND OTHER COMPOUND LENS SYSTEM, INCLUDING DISTANCE VISION TELESC | BR | BR | |
| V2623 | PROSTHETIC EYE, PLASTIC, CUSTOM | $959.84 | $959.84 | |
| V2624 | POLISHING/RESURFACING OF OCULAR PROSTHESIS | $48.82 | $48.82 | |
| V2625 | ENLARGEMENT OF OCULAR PROSTHESIS | $346.16 | $346.16 | |
| V2626 | REDUCTION OF OCULAR PROSTHESIS | $213.33 | $213.33 | |
| V2627 | SCLERAL COVER SHELL | $1,033.36 | $1,033.36 | |
| V2628 | FABRICATION AND FITTING OF OCULAR CONFORMER | $244.00 | $244.00 | |
| V2629 | PROSTHETIC EYE, OTHER TYPE | BR | BR | |
| V2630 | ANTERIOR CHAMBER INTRAOCULAR LENS | BR | BR | |
| V2631 | IRIS SUPPORTED INTRAOCULAR LENS | BR | BR | |
| V2632 | POSTERIOR CHAMBER INTRAOCULAR LENS | BR | BR | |
| V2700 | BALANCE LENS, PER LENS | $46.85 | $46.85 | |
| V2710 | SLAB OFF PRISM, GLASS OR PLASTIC. PER LENS | $64.93 | $64.93 | |
| V2715 | PRISM, PER LENS | $12.43 | $12.43 | |
| V2718 | PRESS-ON LENS, FRESNELL PRISM, PER LENS | $30.53 | $30.53 | |
| V2730 | SPECIAL BASE CURVE, GLASS OR PLASTIC,PER LENS | $21.91 | $21.91 | |
| V2744 | TINT, PHOTOCHROMATIC, PER LENS | $13.16 | $13.16 | |
| V2750 | ANTI-REFLECTIVE COATING, PER LENS | $19.16 | $19.16 | |
| V2755 | U-V LENS, PER LENS | $13.32 | $13.32 | |
| V2760 | SCRATCH RESISTANT COATING, PER LENS | $17.13 | $17.13 | |
| V2770 | OCCLUDER LENS, PER LENS | $20.87 | $20.87 | |
| V2780 | OVERSIZE LENS, PER LENS | $13.40 | $13.40 | |
| V2781 | PROGRESSIVE LENS, PER LENS | BR | BR | |
| V2782 | LENS, INDEX 1.54 TO 1.65 PLASTIC OR 1.60 TO 1.79 GLASS, EXCLUDES POLYCARBON | $50.68 | $50.68 | |
| V2783 | LENS, INDEX GREATER THAN OR EQUAL TO 1.66 PLASTIC OR GREATER THAN OR EQUAL | $57.14 | $57.14 | |
| V2784 | LENS, POLYCARBONATE OR EQUAL, ANY INDEX, PER LENS | $37.16 | $37.16 | |
| V2785 | PROCESSING, PRESERVING AND TRANSPORTING CORNEAL TISSUE | BR | BR | |
| V2790 | AMNIOTIC MEMBRANE FOR SURGICAL RECONSTRUCTION, PER PROCEDURE | BR | BR | |
| V2799 | VISION SERVICE, MISCELLANEOUS | BR | BR | |
| V5008 | HEARING SCREENING | BR | BR | |
| V5010 | ASSESSMENT FOR HEARING AID | BR | BR | |
| V5011 | FITTING/ORIENTATION/CHECKING OF HEARING AID | BR | BR | |
| V5014 | REPAIR/MODIFICATION OF A HEARING AID | BR | BR | |
| V5020 | CONFORMITY EVALUATION | BR | BR | |
| V5030 | HEARING AID, MONAURAL, BODY WORN, AIR CONDUCTION | BR | BR | |
| V5040 | HEARING AID, MONAURAL, BODY WORN, BONE CONDUCTION | BR | BR | |
| V5050 | HEARING AID, MONAURAL, IN THE EAR | BR | BR | |
| V5060 | HEARING AID, MONAURAL, BEHIND THE EAR | BR | BR | |
| V5070 | GLASSES, AIR CONDUCTION | BR | BR | |
| V5080 | GLASSES, BONE CONDUCTION | BR | BR | |
| V5090 | DISPENSING FEE, UNSPECIFIED HEARING AID | BR | BR | |
| V5095 | SEMI-IMPLANTABLE MIDDLE EAR HEARING PROSTHESIS | BR | BR | |
| V5100 | HEARING AID, BILATERAL, BODY WORN | BR | BR | |
| V5110 | DISPENSING FEE, BILATERAL | BR | BR | |
| V5120 | BINAURAL, BODY | BR | BR | |
| V5130 | BINAURAL, IN THE EAR | BR | BR | |
| V5140 | BINAURAL, BEHIND THE EAR | BR | BR | |
| V5150 | BINAURAL, GLASSES | BR | BR | |
| V5160 | DISPENSING FEE, BINAURAL | BR | BR | |
| V5170 | HEARING AID, CROS, IN THE EAR | BR | BR | |
| V5180 | HEARING AID, CROS, BEHIND THE EAR | BR | BR | |
| V5190 | HEARING AID, CROS, GLASSES | BR | BR | |
| V5200 | DISPENSING FEE, CROS | BR | BR | |
| V5210 | HEARING AID, BICROS, IN THE EAR | BR | BR | |
| V5220 | HEARING AID, BICROS, BEHIND THE EAR | BR | BR | |
| V5230 | HEARING AID, BICROS, GLASSES | BR | BR | |
| V5240 | DISPENSING FEE, BICROS | BR | BR | |
| V5241 | DISPENSING FEE, MONAURAL HEARING AID, ANY TYPE | BR | BR | |
| V5242 | HEARING AID, ANALOG, MONAURAL, CIC (COMPLETELY IN THE EAR CANAL) | BR | BR | |
| V5243 | HEARING AID, ANALOG, MONAURAL, ITC (IN THE CANAL) | BR | BR | |
| V5244 | HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, CIC | BR | BR | |
| V5245 | HEARING AID, DIGITALLY PROGRAMMABLE, ANALOG, MONAURAL, ITC | BR | BR | |
| V5246 | HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, ITE (IN THE EAR) | BR | BR | |
| V5247 | HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, BTE (BEHIND THE EAR) | BR | BR | |
| V5248 | HEARING AID, ANALOG, BINAURAL, CIC | BR | BR | |
| V5249 | HEARING AID, ANALOG, BINAURAL, ITC | BR | BR | |
| V5250 | HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, CIC | BR | BR | |
| V5251 | HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, ITC | BR | BR | |
| V5252 | HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, ITE | BR | BR | |
| V5253 | HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, BTE | BR | BR | |
| V5254 | HEARING AID, DIGITAL, MONAURAL, CIC | BR | BR | |
| V5255 | HEARING AID, DIGITAL, MONAURAL, ITC | BR | BR | |
| V5256 | HEARING AID, DIGITAL, MONAURAL, ITE | BR | BR | |
| V5257 | HEARING AID, DIGITAL, MONAURAL, BTE | BR | BR | |
| V5258 | HEARING AID, DIGITAL, BINAURAL, CIC | BR | BR | |
| V5259 | HEARING AID, DIGITAL, BINAURAL, ITC | BR | BR | |
| V5260 | HEARING AID, DIGITAL, BINAURAL, ITE | BR | BR | |
| V5261 | HEARING AID, DIGITAL, BINAURAL, BTE | BR | BR | |
| V5262 | HEARING AID, DISPOSABLE, ANY TYPE, MONAURAL | BR | BR | |
| V5263 | HEARING AID, DISPOSABLE, ANY TYPE, BINAURAL | BR | BR | |
| V5264 | EAR MOLD/INSERT, NOT DISPOSABLE, ANY TYPE | BR | BR | |
| V5265 | EAR MOLD/INSERT, DISPOSABLE, ANY TYPE | BR | BR | |
| V5266 | BATTERY FOR USE IN HEARING DEVICE | BR | BR | |
| V5267 | HEARING AID SUPPLIES / ACCESSORIES | BR | BR | |
| V5268 | ASSISTIVE LISTENING DEVICE, TELEPHONE AMPLIFIER, ANY TYPE | BR | BR | |
| V5269 | ASSISTIVE LISTENING DEVICE, ALERTING, ANY TYPE | BR | BR | |
| V5270 | ASSISTIVE LISTENING DEVICE, TELEVISION AMPLIFIER, ANY TYPE | BR | BR | |
| V5271 | ASSISTIVE LISTENING DEVICE, TELEVISION CAPTION DECODER | BR | BR | |
| V5272 | ASSISTIVE LISTENING DEVICE, TDD | BR | BR | |
| V5273 | ASSISTIVE LISTENING DEVICE, FOR USE WITH COCHLEAR IMPLANT | BR | BR | |
| V5274 | ASSISTIVE LEARNING DEVICE, NOT OTHERWISE SPECIFIED | BR | BR | |