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| UEC Fee Schedule 2022 | ||
|---|---|---|
| Effective: 8/22/22 | ||
| Examination, Treatment and Procedures | ||
| Procedure Code | Fee (in US dollars) | Description |
| 0207T | 175 | Lipiflow Treatment (per eye) |
| 64612 | 250 | Destroy nerve, face muscle |
| 65205 | 125 | Foreign Body Removal, Conjunctival, Superficial |
| 65210 | 125 | Foreign Body Removal, Conjunctival, Embedded |
| 65222 | 125 | Foreign Body Removal, Corneal, Slit Lamp |
| 65430 | 500 | Corneal Scraping, Diagnostic, Smear or Culture |
| 65600 | 650 | Stromal Puncture |
| 65778 | 1900 | Prokera (Amniotic Membrane) |
| 65855 | 700 | Trabeculoplasty By Laser |
| 66761 | 700 | Iridotomy/Iridectomy, By Laser |
| 66821 | 700 | Laser Surgery, Lens (YAG) |
| 66984 55 (modifier 55 for comanagement) | 200 | Comanagement of Post-Op Portion of Extracapsular Cataract Removal With Insertion of IOL |
| 67028 | 200 | Injection Eye Drug |
| 67105 | 750 | Retina or Choroid Repair, Photocoagulation |
| 67145 | 750 | Retina or Choroid Prophylaxis, Photocoagulation |
| 67210 | 750 | Retina or Choroid Destruction, Localized Lesion, Photocoagulation |
| 67228 | 750 | Retina or Choroid Destruction, Treatment of Extensive Retinopathy, Photocoagulation |
| 67515 | 150 | Injection of Medication or Other Substance Into Tenons Capsule |
| 67800 | 275 | Excision of Chalazion, Single |
| 67805 | 500 | Excision of Chalazion, Multiple, Different Lids |
| 67820 | 100 | Correction of Trichiasis, Epilation, Forceps |
| 67825 | 250 | Correction of trichiasis; epilation, by methods other than forceps (e.g., electrosurgery) |
| 67840 | 650 | Excision of Lesion of Eyelid (Except Chalzaion) Without Closure or With Simple Direct Closure |
| 68761 | 250 | Closure of Lacrimal Punctum by Plug |
| 68801 | 175 | Dilation of Lacrimal Punctum, With or Without Irrigation |
| 68840 | 175 | Probing of Lacrimal Canaliculi, With or Without Irrigation |
| 76510 | 250 | Ophthalmic Ultrasound, Diagnostic, B-scan and Quantitative A-scan Performed During Same Patient Encounter |
| 76511 | 165 | Ophthalmic Ultrasound, Quantitative A-scan Only |
| 76512 | 165 | Ophthalmic Ultrasound, B-scan, With or Without Non-quantitative A-scan |
| 76513 | 175 | Anterior Segment Ultrasound, Immersion B-scan or High Resolution Biomicroscopy |
| 76514 | 50 | Corneal Pachymetry, Unilateral or Bilateral |
| 76519 | 130 | Ophthalmic Biometry by Ultrasound, A-scan, With IOP Power Calculation |
| 83516 | 40 | Immunoassay for Other Than Infectious Agent (InflammaDry) |
| 83861 | 40 | Tear Osmolarity Testing |
| 90791 | 400 | Psychiatric Diagnostic Evaluation (Intake Interview) |
| 92000 | 300 | Perceptual Evaluation |
| 92000HT | 200 | Perceptual Eval/Skills |
| 92002 | 120 | Ophthalmological Services, Intermediate, New Patient |
| 92004 | 180 | Ophthalmological Services, Comprehensive, New Patient |
| 92012 | 110 | Ophthalmological Services, Intermediate, Established Patient |
| 92014 | 155 | Ophthalmological Services, Comprehensive, Established Patient |
| 92015 | 55 | Determination of Refractive State |
| 92015-22 | 150 | Determination of Refractive State - Complex |
| 92020 | 50 | Gonioscopy |
| 92025 | 125 | Computerized Corneal Topography |
| 92060 | 90 | Sensorimotor Examination |
| 92065 | 85 | Orthoptic Training |
| 92081 | 80 | Visual Field Examination, Limited |
| 92082 | 105 | Visual Field Examination, Intermediate |
| 92083 | 145 | Visual Field Examination, Extended |
| 92100 | 125 | Serial Tonometry |
| 92132 | 105 | Scanning Computerized Ophthalmic Diagnostic Imaging, Anterior Segment |
| 92133 | 105 | Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment, Optic Nerve |
| 92134 | 105 | Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment, Retina |
| 92136 | 170 | Ophthalmic Biometry by Partial Coherence Interferometry With IOL Power Calculation |
| 92145 | 40 | Corneal Hysteresis Determination, By Air Impulse Stimulation |
| 92201 | 40 | Ophthalmoscopy, Extended, Initial |
| 92202 | 35 | Ophthalmoscopy, Extended, Subsequent |
| 92235 | 175 | Fluorescein Angiography |
| 92250 | 190 | Fundus Photography |
| 92270 | 130 | Electro-oculography |
| 92273 | 250 | Electroretinography - Full Field |
| 92274 | 150 | Electroretinography - Multifocal |
| (0509T) | 150 | Electroretinography - Pattern |
| 92283 | 225 | Color Vision Eximination, Extended |
| 92285 | 85 | External Ocular Photography |
| 92286 | 100 | Anterior Segment Imaging, With Specular Microscopy |
| 95930 | 210 | Visually Evoked Potential (VEP) |
| 96132 | 250 | Neuropsychological Testing Evaluation Services by Physician or Other Qualified Health Care Professional, Including Integration of Patient Data, Interpretation of Standardized Test Results and Clinical Data, Clinical Decision Making, Treatment Planning and Report, and Interactive Feedback to the Patient, Family Member(s) or Caregiver(s), When Performed, First Hour |
| 96133 | 175 | Neuropsychological Testing Evaluation Services, Each Additional Hour (Add on Code) |
| 99075 | 500* 250** | Medical Testimony *Initial, Up to Two Hours **Each Additional Hour |
| 99201 | 65 | Office Visit, New Patient |
| 99202 | 95 | Office Visit, New Patient |
| 99203 | 140 | Office Visit, New Patient |
| 99204 | 200 | Office Visit, New Patient |
| 99205 | 265 | Office Visit, New Patient |
| 99211 | 40 | Office Visit, Established Patient |
| 99212 | 70 | Office Visit, Established Patient |
| 99213 | 110 | Office Visit, Established Patient |
| 99214 | 155 | Office Visit, Established Patient |
| 99215 | 215 | Office Visit, Established Patient |
| 99241 | 80 | Office Consultation , New or Established Patient |
| 99242 | 125 | Office Consultation , New or Established Patient |
| 99243 | 160 | Office Consultation , New or Established Patient |
| 99244 | 215 | Office Consultation , New or Established Patient |
| 99245 | 280 | Office Consultation , New or Established Patient |
| 99EHV | 100 | External Home Visit |
| J9035 | 100 | Bevacizumab injection |
| J0585 | 8 | Botulinum toxin (1unit) |
| J0178 | 950 | Eylea (1mg) |
| VU99203 | 140 | Vuity Initial Visit |
| VU99213 | 110 | Vuity Established Patient Visit |
| VU99212 | 70 | Vuity Recheck |
| Contact Lens Services and Materials | ||
| Procedure Code | Fee (in dollars) | Description |
| 92071 | 175 | Fitting of Contact Lens for Treatment of Ocular Service Disease (bandage contact lens) |
| 92072 | 700 | Fitting of Contact Lens for Management of Keratoconus, Initial, Bilateral |
| 92310-52 | 350 | Degenerative Myopia Intial Fit (bilateral) |
| 92310 | 700 | Prescription of Optical and Physical Characteristics of and Fitting of Contact Lens, Medically Necessary, Both Eyes (except aphakia) |
| 92311 | 375 | Fitting of Medically Necessary Contact Lens, Aphakia, 1 Eye |
| 92312 | 500 | Fitting of Medically Necessary Contact Lens, Aphakia, Aphakia, Both Eyes |
| 92313 | 350 | Fitting of Medically Necessary Contact Lens, Corneoscleral Lens, 1 Eye |
| V2513 | Starting at 150 per lens | Contact Lens, Rigid Gas Permeable |
| V2521 | Starting at 45 per box | Soft Lenses: Toric |
| V2522 | Starting at 50 per box | Soft Lenses: Multifocal |
| V2523 | Starting at 40 per box | Soft Lenses: Spherical |
| V2599 | Starting at $325 per lens | Contact Lens, Orthokeratology |
| V2531 | Starting at 575 per lens | Scleral Lens |
| V2623 | 2400 | Prosthetic Eye, Plastic, Custom, Per Eye |
| V2624 | 100 | Polishing/Resurfacing |
| V2625 | 500 | Enlargement Of Ocular Prosthesis |
| V2626 | 500 | Reduction/Ocular Prosthesis |
| V2627 | 2000 | Sclera Cover Shell |
| CL12 | 600 | Cosmetic Rigid Gas Permeable Contact Lens Professional Fee: Scleral/Hybrid |
| CL14 | 550 | Orthokeratology- Refit Not Including Lenses |
| CL15 | 75 | Intermediate Contact Lens/Eye Health Assessment- Elective Wearer |
| CL101 | 75 | Annual Soft Contact Lens Evaluation During Comprehensive Examination |
| CL102 | 100 | Annual GP Contact Lens Evaluation During Comprehensive Examination |
| CL103 | 150 | Cosmetic Contact Lens Professional Fee: Soft Refit Existing Wearer Same Lens Design in Toric or Multifocal /Rigid Gas Permeable Refit, Change in Power Only |
| CL104 | 150 | Cosmetic Soft Contact Lens Professional Fee: Standard Fit |
| CL105 | 200 | Cosmetic Soft Contact Lens Professional Fee: Premium Fit |
| CL106 | 250 | Cosmetic Rigid Gas Permeable Contact Lens Professional Fee |
| CL108 | 1350 | Orthokeratology - Initial Fit Not Including Lenses |
| CLKIT | 25 | Scleral Lens Kit |
| CLDMV | 15 | Scleral Lens Insertion and Removal Plungers |
| Vision Rehabilitation Materials | ||
| Code | Fee (in dollars) | Description |
| VTKIT | 65 | Vision Skills Kit |
| STAMK | 75 | Strabismus Kit |
| ED101 | 450 | Educational/Achievment Testing |
| Optical Materials | ||
| Code | Fee (in dollars) | Description |
| V2020 | start at 69 | Frames |
| V2100 | 69 per pair | SV, sph, plano to +/-4.00 |
| V2103 | 69 per pair | SV, spherocyl, plano to +/-4.00 up to 2.00 D cyl |
| V2200 | 95 per pair | Bifocal, sph, plano to +/-4.00 |
| V2203 | 95 per pair | Bifocal, spherocyl, plano to +/-4.00 up to 2.00D cyl |
| V2219 | 35 additional per pair | Seg over 28mm |
| V2220 | 30 additional per pair | Bifocal add +3.25 to +4.00 |
| V2300 | 169 per pair | Trifocal, sph, plano to +/-4.00 |
| V2303 | 169 per pair | Trifocal, spherocyl, plano to +/-4.00 up to 2.00 cyl |
| V2319 | 35 additional per pair | Trifocal seg over 28mm |
| V2320 | 35 additional per pair | Trifocal add over +3.25 to +4.00 |
| V2715 | 15 | Prism per diopter per eye |
| V2744 | 110 per pair | Tint, plastic photochromatic |
| V2745 | 25 per pair | Tint, anything except photochromatic |
| V2750 | Range from 80 to 175 per pair | A/R coating |
| V2755 | 30 per pair | U-V coating |
| V2760 | 25 per pair | S-R coating |
| V2762 | 150 per pair | Polarization |
| V2781 | Starting at 160 additional per pair over fee for bifocals | Progressive |
| V2783 | Starting at 80 additional per pair over fee for standard lenses | High Index |
| V2784 | 50 additional | Polycarb |
| Kids Packages Rx range = +/- 4.00 with -2.00 cyl | 99, 149, 189, 249 | Frame and SV polycarbonate lenses |
| Sports Glasses Rx range = +/- 4.00 with -2.00 cyl | 199 | Select Liberty Sports Goggles and SV clear polycarbonate lenses |
| Telehealth | ||
| Procedure Code | Fee (in dollars) | Description |
| 99212 | 100 | Telehealth - Office Visit, Established Patient |
| 99213 | 130 | Telehealth - Office Visit, Established Patient |
| 99202 | 120 | Telehealth - Office Visit, New Patient |
| 99441 | 100 | Phone, Eval & Management 5-10 Min |
| 99442 | 130 | Phone, Eval & Management 11-20 Min |
| 99443 | 160 | Phone, Eval & Management 21-30 Min |
| G2012 | 25 | Brief Check-in (5-10 minutes) |
| G2010 | 20 | Remote Image Review |
| 99453 | 35 | RPM - Training |
| 99454 | 90 | RPM - Loaned Device |
| 99457 | 90 | RPM - Analysis and Discussion |
| Myopia Managment | ||
| Procedure Code | Fee (in US dollars) | Description |
| MC01 | 50 | Initial Consultation Visit |
| MC02 | 300 | Baseleine Evaluation |
| MC03 | 250 | Annual Evaluation |
| CL20 | 300 | Myopia Control Soft Multifocal CL Fit |
| CL21 | 1350 | Myopia Control Orthokeratology CL Fit Not Including Lenses |
| CL22 | 75 | CL Assessment with Annual Myopia Control Visit |
| CL23 | 200 | Myopia Control Soft Multifocal CL Refit |
| CL24 | 550 | Myopia Control Orthokeratology CL Refit Not Including Lenses |
