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Send Letter to Establish Medical Necessity of Contact Lenses – Donna McCune, COE, CCS-P

Third-party payors generally consider contact lenses to be cosmetic and not medically necessary. The definition of “medical necessity” may very by payor. Medicare reimburses for aphakic contact lenses that are worn at the same time as glasses, and may reimburse for replacement lenses based on medical necessity. For example, an aphakic glaucoma patient using multiple eye medications may require frequent contact lens replacements, as the drops may cause the a rapid deterioration of the lens clarity.

Ophthalmology Compliance & Reimbursement Insider; August 2004.

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