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Fact Sheet

Refractive Lenses

Use this fact sheet for help with billing and providing refractive lenses. We have also listed helpful resources at the bottom of this page.

  1. Refractive lenses are covered when they are used to restore the vision normally provided by the natural lens of the eye of an individual lacking the organic lens because of surgical removal or congenital absence.
  2. Covered diagnoses are limited to:
    1. pseudophakia (condition in which the natural lens has been replaced with an artificial intraocular lens [IOL]),
    2. aphakia (condition in which the natural lens has been removed but there is no IOL), and
    3. congenital aphakia.
  3. Lenses provided for other diagnoses will be denied as noncovered.

    Note: For beneficiaries with pseudophakia, one pair of eyeglasses or contact lenses after each cataract surgery (with insertion of and IOL) is covered.
  • Medicare only covers standard frames (V2020).
    • When billing claims for deluxe frames, use code V2020 to bill the cost of standard frames. On the second line, use code V2025 (deluxe frames) to bill the difference between the deluxe frame charge and the standard frame charge.
  • See the Coding Guidelines and Coding Information in the Refractive Lenses Policy Article (A52499)External Website .
  • If you have questions about coding, visit the Pricing, Data Analysis and Coding (PDAC)External Website website .

Diagnosis Codes

If the beneficiary doesn’t have one of the above diagnosis codes in their medical records and on the claim, your claim will deny as not covered.

See Standard Documentation Requirements for All Claims Submitted to the DME MACs Policy Article A55426.External Website

RT (right) and LT (left) Modifiers

  • Most HCPCS codes in this policy require the RT (right) and LT (left) modifiers. These 3 HCPCS codes are the only ones in this policy that don’t require an RT or LT modifier:
  • V2020
  • V2025
  • V2600

When you provide lenses bilaterally and use the same code for both lenses, bill each item on 2 separate claims lines. Bill each code with the RT or LT modifiers and 1 unit of service on each claim line. 

  • If an RT or LT is required on the claim line and is not present, we’ll reject the claim for incorrect coding.
  • If an RT or LT is required and they are billed on the same line with 2 UOS, we’ll reject the claim for incorrect coding.

KX, GA, GY, GZ, & EY Modifiers

  • The only 5 HCPCS codes in this policy that require the KX, GA, GY, or GZ modifiers: 
    • V2750
    • V2744
    • V2745
    • V2780
    • V2784
  • If you don’t use the  KX, GA, GY, or GZ modifier for these 5 HCPCS codes, we’ll reject the claim for missing information.
  • Modifier Definitions:
    • KX Modifier: Indicates all criteria within the LCD have been met
    • GA: Indicates that a valid ABN is on file, and item is expected to be denied not reasonable and necessary
    • GY: Indicates item or service statutorily excluded or doesn’t meet the definition of any Medicare benefit category
    • GZ: Indicates no valid ABN on file and item is expected to be denied not reasonable and necessary
    • EY: No physician or other licensed health care provider order for this item or service

For help with using the correct modifiers when billing refractive lenses, use our Advanced Modifier Engine (AME).

  1. Why do I get denials for “invalid place of service”?

    Bill DMEPOS where the item will be used.  Don’t use place of service 11 for office. For example, a valid place of service for DMEPOS is 12 for “home”. See the Jurisdiction B Supplier Manual, Chapter 6PDF for information on place of service.
  2. Which jurisdiction do I bill?

    Bill DMEPOS to the jurisdiction covered for the beneficiary’s address on file with the Social Security Administration (SSA).  Confirm the beneficiary’s address with SSA before billing the claim.
  3. How can I find out if the beneficiary has a Medicare Advantage Plan?

    As part of your intake, ask the beneficiary for their most recent insurance card. Use the myCGS DMEPOS Web Portal to check beneficiary eligibility.  If you aren’t registered for the portal, see our myCGS Registration & Account Management Guide.

Resources

Published: 09.03.2026

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