Statutes, codes, and regulations
California Code Of Regulations
Title 22 - Social SecurityDivision 3 - Health Care ServicesSubdivision 1 - California Medical Assistance ProgramChapter 3 - Health Care Services
Article 7 - Payment for Services and Supplies
Section 51519 - Eye Appliances

Cal. Code Regs. tit. 22 § 51519

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Current through Register 2024 Notice Reg. No. 45, November 8, 2024
Section 51519 - Eye Appliances
(a) General Provisions.
(1) The reimbursement for eye appliances shall be in accordance with maximum reimbursement rates listed below; however, billing shall not exceed charges made to the general public.
(2) The listed allowances include impact resistance and testing, oversize lenses, special beveling, drilling, mounting, fitting and adjusting, loaners for postcataract cases, sales taxes paid by the provider, and follow-up services for a period of six months after date of service.
(3) "Diopters" refers to the power of the strongest meridian of the major portion of the lens, the maximum cylindrical power, or the power of the segment addition, as appropriate.
(4) When a Medi-Cal beneficiary resides in a geographic area where a fabricating optical laboratory has entered into an exclusive area negotiated contract with the Department, the lens dispensing fees listed in Section 51519.1(b) shall be used instead of HCPCS codes V2100 through V2430, and V2700 through V2755 listed in (b) below. When a fabricating optical laboratory, which has entered into an exclusive area negotiated contract with the Department, also supplies the frames, the frame dispensing fee listed in Section 51519.1(b) shall be used instead of HCPCS codes V2020 and Z2910 through Z2916 listed in (b) below.
(b) Maximum reimbursement rates for eye appliances shall be as follows:

Procedure CodeSection Maximum Allowance per Lens
(1) Spectacle Lenses

SINGLE VISION GLASS OR PLASTIC

V2100Sphere, single vision, plano to plus or minus 4.00, per lens..........................$18.30
V2101Sphere, single vision, plus or minus 4.12 to plus or minus 7.00D, per lens..........................21.69
V2102Sphere, single vision, plus or minus 7.12 to plus or minus 20.00D, per lens..........................25.75
V2103Spherocylinder, single vision, plano to plus or minus 4.00D sphere, .12 to 2.00D cylinder, per lens..........................18.48
V2104Spherocylinder, single vision, plano to plus or minus 4.00D sphere 2.12 to 4.00D cylinder, per lens..........................18.62
V2105Spherocylinder, single vision, plano to plus or minus 4.00D sphere, 4.25 to 6.00D cylinder, per lens..........................29.39
V2106Spherocylinder, single vision, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens..........................31.14
V2107Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, .12 to 2.00D cylinder, per lens..........................21.89
V2108Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 up to 4.00D cylinder, per lens..........................22.18
V2109Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens..........................33.01
V2110Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens..........................37.34
V2111Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens..........................25.74
V2112Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25D to 4.00D cylinder, per lens..........................25.74
V2113Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens..........................37.40
V2114Spherocylinder, single vision, sphere over plus or minus 12.00D, per lens..........................29.90
V2115Lenticular (myodisc), per lens, single vision..........................77.05
V2116Lenticular lens, nonaspheric, per lens, single vision..........................51.17
V2117Lenticular, aspheric, per lens, single vision..........................57.00
V2410Variable asphericity lens, single vision, full field, glass or plastic, per lens..........................57.05

BIFOCAL GLASS OR PLASTIC

V2200Sphere, bifocal, plano to plus or minus 4.00D, per lens..........................$29.39
V2201Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00D, per lens..........................36.38
V2202Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00D, per lens..........................42.60
V2203Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, .12 to 2.00D cylinder, per lens..........................29.76
V2204Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, 2.12 to 4.00D cylinder, per lens..........................29.77
V2205Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, 4.25 to 6.00D cylinder, per lens..........................43.91
V2206Spherocylinder, bifocal, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens..........................44.17
V2207Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00D cylinder, per lens..........................36.41
V2208Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 to 4.00D cylinder, per lens..........................38.48
V2209Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens..........................49.81
V2210Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens..........................51.64
V2211Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens..........................42.31
V2212Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25 to 4.00D cylinder, per lens..........................42.60
V2213Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens..........................52.37
V2214Spherocylinder, bifocal, sphere over plus or minus 12.00D, per lens..........................44.87
V2215Lenticular, (myodisc), per lens, bifocal..........................95.89
V2216Lenticular, nonaspheric, per lens, bifocal..........................87.40
V2217Lenticular, aspheric lens, bifocal..........................97.71
V2220Bifocal add over 3.25D..........................14.31
V2430Variable asphericity lens, bifocal, full field, glass or plastic, per lens..........................97.71
TRIFOCAL GLASS OR PLASTIC
V2300Sphere, trifocal, plano to plus or minus 4.00D, per lens..........................$ 42.35
V2301Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00D, per lens..........................46.42
V2302Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00D, per lens..........................54.33
V2303Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, 12-2.00D cylinder, per lens..........................42.59
V2304Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, 2.25-4.00D cylinder, per lens..........................50.21
V2305Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, 4.25-6,00D cylinder, per lens..........................55.10
V2306Spherocylinder, trifocal, plano to plus or minus 4.00D sphere, over 6.00D cylinder, per lens..........................55.36
V2307Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, .12 to 2.00D cylinder, per lens..........................47.60
V2308Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 2.12 to 4.00D cylinder, per lens..........................47.60
V2309Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, 4.25 to 6.00D cylinder, per lens..........................61.83
V2310Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00D sphere, over 6.00D cylinder, per lens..........................62.09
V2311Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, .25 to 2.25D cylinder, per lens..........................54.33
V2312Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 2.25 to 4.00D cylinder, per lens..........................54.59
V2313Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00D sphere, 4.25 to 6.00D cylinder, per lens..........................62.09
V2314Spherocylinder, trifocal, sphere over plus or minus 12.00D, per lens..........................54.33
V2315Lenticular (myodisc), per lens, trifocal..........................By Report
V2316Lenticular, nonaspheric lens, trifoca..........................lBy Report
V2317Lenticular, aspheric lens, trifocal..........................By Report
V2320Trifocal add over 3.25D..........................14.31
(2) Corneal Lenses
V2500Contact lens, PMMA, spherical, per lens..........................$ 65.94
V2501Contact lens, PMMA, toric or prism ballast, per lens..........................103.69
Z2900Contact lens, PMMA or gas permeable, replacement, per lens..........................71.32
V2510Contact lens, gas permeable, spherical, per lens..........................88.64
V2511Contact lens, gas permeable, toric or prism ballast, per lens..........................143.27
V2513Contact lens, gas permeable, extended wear, per lens..........................152.59
V2520Contact lens, hydrophilic, spherical, per lens..........................78.21
V2521Contact lens, hydrophilic, toric or prism ballast, per lens..........................136.15
Z2902Contact lens, hydrophilic, replacement..........................71.32
V2523Contact lens, hydrophilic, extended wear, per lens..........................112.92
Z2908Contact lens, extended wear, replacemement..........................97.59
Z2904Thermal hydrophilic lens care kit..........................37.59
Z2906Bandage contact lenses..........................56.77
(3) Miscellaneous Lens Items
V2700Balance lens, per lens..........................50 percent of of allowance for comparable single vision lens
V2710Slab off prism, glass or plastic, per lens..........................40.00
V2715Prism, per lens..........................8.17
V2718Press-on lens, Fresnell prism, per lens..........................15.78
V2740Tint, plastic, rose 1 or 2, per lens..........................By Report
V2741Tint, plastic, other than rose 1 or 2, per lens..........................By Report
V2742Tint, glass, rose 1 or 2, per lens..........................By Report
V2743Tint, glass, other than rose 1 or 2, per lens..........................By Report
V2744Tint, photochromatic, per lens..........................By Report
V2755U-V lens, per lens..........................By Report
(4) Frames
V2020Frames, purchase..........................21.31
Z2910Arm with adjustable pad..........................5.91
Z2912Front--zyl (replace or repair)..........................11.18
Z2914Front--combination or metal (replace or repair)..........................12.66
Z2916Temple--all types (replace)..........................6.70
(5) Low Vision Aids
V2600Hand held low vision aids and other non-spectacle mounted aids..........................By Report
V2610Single lens spectacle mounted low vision aids..........................By Report
V2615Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system..........................By Report
(6) Prosthetic Eyes
V2623Prosthetic eye, plastic, custom..........................By Report
V2624Polishing and resurfacing of ocular prosthesis..........................$31.96
V2625Enlargement of ocular prosthesis..........................By Report
V2626Reduction of ocular prosthesis..........................By Report
V2627Scleral cover shell..........................By Report
V2628Fabrication and fitting of ocular conformer..........................By Report
V2629Prosthetic eye, other type..........................By Report
(7) Miscellaneous Nonlens Items
Z2918Occluder, clip patch style..........................6.70
Z2920Occluder, cup..........................7.83
Z2926Headband..........................2.84
Z2928Nosepads, nosepad covers, temple covers..........................2.27
V2799Not otherwise classified..........................By Report

Cal. Code Regs. Tit. 22, § 51519

1. Amendment filed 11-28-88 as an emergency; operative 11-28-88 (Register 89, No. 11). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-28-89. For prior history, see Register 86, No. 46.
2. Certificate of Compliance as to 11-28-88 order transmitted to OAL 3-27-89 and filed 4-26-89 (Register 89, No. 18).
3. Repealer and new section filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsection (b)(6) filed 9-29-93 as an emergency; operative 9-29-93 (Register 93, No. 40). A Certificate of Compliance must be transmitted to OAL 1-27-94 or emergency language will be repealed by operation of law on the following day.
6. Editorial correction amending HISTORY 5 (Register 93, No. 46).
7. Certificate of Compliance as to 9-23-93 order transmitted to OAL 10-29-93 and filed 11-8-93 (Register 93, No. 46).
8. Amendment of subsections (b)(2) and (b)(6) filed 8-27-99 as an emergency; operative 8-30-99 (Register 99, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-28-99 or emergency language will be repealed by operation of law on the following day.
9. Amendment of subsections (b)(2) and (b)(6) refiled 12-27-99 as an emergency; operative 12-28-99 (Register 99, No. 53). A Certificate of Compliance must be transmitted to OAL by 4-26-2000 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsections (b)(2) and (b)(6) refiled 4-24-2000 as an emergency; operative 4-26-2000 (Register 2000, No. 17). A Certificate of Compliance must be transmitted to OAL by 8-24-2000 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 4-24-2000 order transmitted to OAL 5-24-2000 and filed 7-6-2000 (Register 2000, No. 27).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code; and Section 87, Chapter 1594, Statutes of 1982. Reference: Sections 14105 and 14105.3, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; and Statutes of 1985, Chapter 111, Items 4260-106-001 and 890.

1. Amendment filed 11-28-88 as an emergency; operative 11-28-88 (Register 89, No. 11). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-28-89. For prior history, see Register 86, No. 46.
2. Certificate of Compliance as to 11-28-88 order transmitted to OAL 3-27-89 and filed 4-26-89 (Register 89, No. 18).
3. Repealer and new section filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsection (b)(6) filed 9-29-93 as an emergency; operative 9-29-93 (Register 93, No. 40). A Certificate of Compliance must be transmitted to OAL 1-27-94 or emergency language will be repealed by operation of law on the following day.
6. Editorial correction amending History 5 (Register 93, No. 46).
7. Certificate of Compliance as to 9-23-93 order transmitted to OAL 10-29-93 and filed 11-8-93 (Register 93, No. 46).
8. Amendment of subsections (b)(2) and (b)(6) filed 8-27-99 as an emergency; operative 8-30-99 (Register 99, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-28-99 or emergency language will be repealed by operation of law on the following day.
9. Amendment of subsections (b)(2) and (b)(6) refiled 12-27-99 as an emergency; operative 12-28-99 (Register 99, No. 53). A Certificate of Compliance must be transmitted to OAL by 4-26-2000 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsections (b)(2) and (b)(6) refiled 4-24-2000 as an emergency; operative 4-26-2000 (Register 2000, No. 17). A Certificate of Compliance must be transmitted to OAL by 8-24-2000 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 4-24-2000 order transmitted to OAL 5-24-2000 and filed 7-6-2000 (Register 2000, No. 27).