Cal. Code Regs. tit. 22 § 51519.2

Current through Register 2024 Notice Reg. No. 24, June 14, 2024

Section 51519.2 - Reimbursement Rates for Ophthalmic Appliances Supplied by a Fabricating Optical Laboratory Under an Exclusive Area Negotiated Contract

(a) General Provisions.

(1) Reimbursement rates listed in (b) below include lens grinding, cutting, edging, impact resistance and testing, oversize lenses, special beveling, drilling and mounting.

(2) "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.

(b) Maximum reimbursement rates payable under an exclusive area negotiated contract for eye appliances shall be as follows:

(1) Spectacle Lenses.

*Procedure Code*	*Maximum Reimbursement Rates per Lens*
SINGLE VISION GLASS

Z3100	0.00-4.00 diopters..........................	..........................$ 7.34
Z3102	4.12-7.00 diopters..........................	..........................7.68
Z3104	7.12-20.00 diopters..........................	..........................19.79
Z3106	Lenticular..........................	..........................28.44
BIFOCAL GLASS

Z3108	0.00-4.00 diopters..........................	..........................$10.95
Z3110	4.12-7.00 diopters..........................	..........................12.60
Z3112	7.12-20.00 diopters..........................	..........................21.60
Z3114	Lenticular..........................	..........................40.14
TRIFOCAL GLASS

Z3116	0.00-4.00 diopters..........................	..........................$15.65
Z3118	4.12-7.00 diopters..........................	..........................16.94
SINGLE VISION PLASTIC

Z3120	0.00-4.00 diopters..........................	..........................$8.32
Z3122	4.12-6.00 diopters..........................	..........................9.56
Z3124	6.12-10.00 diopters..........................	..........................12.43
Z3126	10.12-14.00 diopters..........................	..........................15.00
Z3128	14.12-18.00 diopters..........................	..........................15.00
Z3130	Aspheric (lenticular or full field)..........................	..........................28.60
Z3132	Lenticular, nonaspheric, plus..........................	..........................26.65
Z3134	Lenticular, nonaspheric, minus..........................	..........................32.30
BIFOCAL PLASTIC

Z3136	0.00-4.00 diopters..........................	..........................$13.04
Z3138	4.12-6.00 diopters..........................	..........................15.32
Z3140	6.12-10.00 diopters..........................	..........................18.01
Z3142	10.12-14.00 diopters..........................	..........................28.92
Z3144	14.12-18.00 diopters..........................	..........................28.92
Z3146	Aspheric (lenticular or full field)..........................	..........................46.15
Z3148	Lenticular, nonaspheric, plus..........................	..........................31.20
Z3150	Lenticular, nonaspheric, minus..........................	..........................35.42
TRIFOCAL PLASTIC

Z3152	0.00-4.00 diopters..........................	..........................$20.15
Z3154	4.12-7.75 diopters..........................	..........................22.17
Z3156	8.00-14.00 diopters..........................	..........................32.18

(2) Miscellaneous Lens Items.

Z3158	Balance lens..........................	50 percent of allowance for comparable single vision lens
Z3160	4.00-6.00 diopter, cylinder..........................	..........................$1.81
Z3162	Prism (if available from stock blank)..........................	..........................4.22
Z3164	Bifocal--adds 4.00 diopter or higher..........................	..........................13.00
Z3166	Absorptive characteristics..........................	..........................By Report
Z3168	Higher powers than listed (per diopter)..........................	..........................2.48
Z3170	Slab-off..........................	..........................26.00
Z3172	Fresnel prism..........................	..........................11.05

(3) Frames.

Z3174	Frame--zyl..........................	..........................$9.50
Z3176	Frame--(metal only)..........................	..........................16.20
Z3178	Arm with adjustable pad..........................	..........................3.75
Z3180	Front--zyl (replace supplied frames)..........................	..........................4.80
Z3182	Front--metal only (replace supplied frames)..........................	..........................10.40
Z3184	Temple--(replace supplied frames)..........................	..........................2.35

Cal. Code Regs. Tit. 22, § 51519.2

1. New section 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.
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. Amendment of section heading and subsections (b)(1)-(b)(3) 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 including amendment of subsection (b)(3) transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsections (a) and (b) and new NOTE filed 10-1-92 with Secretary of State by Department of Health Services; operative 10-1-92. Submitted to OAL for printing only pursuant to section 147(c), SB 485, (Chapter 722, Statutes of 1992) (Register 92, No. 40).

Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code; and Section 87, Chapter 1594, Statutes of 1982. Reference: Sections 14105.3 and 14132, Welfare and Institutions Code.

1. New section 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.
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. Amendment of section heading and subsections (b)(1)-(b)(3) 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 including amendment of subsection (b)(3) transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
5. Amendment of subsections (a) and (b) and new Note filed 10-1-92 with Secretary of State by Department of Health Services; operative 10-1-92. Submitted to OAL for printing only pursuant to section 147(c), SB 485, (Chapter 722, Statutes of 1992) (Register 92, No. 40).