Neighborhood Health Plan of Rhode Island (Neighborhood) has recently revised its Vision Care Services Payment Policy to align with industry standard. The updated Vision Care Services Payment Policy combines guidance that was formerly documented in Neighborhood’s Vision Care Services Billing Guidelines and Ophthalmology Billing Guidelines.
Please see the below changes that will be effective for dates of service on/after March 1, 2022 for all Neighborhood lines of business:
- Refraction services (92015) are not separately reimbursable when billed with a routine or medical eye exam or an evaluation and management (E/M) service. Refraction services are separately reimbursable when billed on their own, i.e., without an eye exam or E/M service.
- Fitting of eyeglasses is not reimbursable (92340, 92341, and 92342), unless billed with new frames and/or lenses.
- Repair and refitting of eyeglasses is not separately reimbursable (92370).
The above information was sent in a formal notification to all Neighborhood contracted vision care providers via USPS on December 24, 2021. All Neighborhood payment policies, including the revised payment policy for Vision Care Services, can be found on the Billing Guidelines and Payment Policies webpage. After March 1, 2022 Neighborhood’s Vision Care Services Billing Guidelines and Ophthalmology Billing Guidelines will be published on Neighborhood’s Billing Guidelines and Payment Policies Archive webpage.