Cal. Code Regs. tit. 22 § 51519.2

Current through Register 2024 Notice Reg. No. 23, June 7, 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

Z31000.00-4.00 diopters....................................................$ 7.34
Z31024.12-7.00 diopters....................................................7.68
Z31047.12-20.00 diopters....................................................19.79
Z3106Lenticular....................................................28.44

BIFOCAL GLASS

Z31080.00-4.00 diopters....................................................$10.95
Z31104.12-7.00 diopters....................................................12.60
Z31127.12-20.00 diopters....................................................21.60
Z3114Lenticular....................................................40.14

TRIFOCAL GLASS

Z31160.00-4.00 diopters....................................................$15.65
Z31184.12-7.00 diopters....................................................16.94

SINGLE VISION PLASTIC

Z31200.00-4.00 diopters....................................................$8.32
Z31224.12-6.00 diopters....................................................9.56
Z31246.12-10.00 diopters....................................................12.43
Z312610.12-14.00 diopters....................................................15.00
Z312814.12-18.00 diopters....................................................15.00
Z3130Aspheric (lenticular or full field)....................................................28.60
Z3132Lenticular, nonaspheric, plus....................................................26.65
Z3134Lenticular, nonaspheric, minus....................................................32.30

BIFOCAL PLASTIC

Z31360.00-4.00 diopters....................................................$13.04
Z31384.12-6.00 diopters....................................................15.32
Z31406.12-10.00 diopters....................................................18.01
Z314210.12-14.00 diopters....................................................28.92
Z314414.12-18.00 diopters....................................................28.92
Z3146Aspheric (lenticular or full field)....................................................46.15
Z3148Lenticular, nonaspheric, plus....................................................31.20
Z3150Lenticular, nonaspheric, minus....................................................35.42

TRIFOCAL PLASTIC

Z31520.00-4.00 diopters....................................................$20.15
Z31544.12-7.75 diopters....................................................22.17
Z31568.00-14.00 diopters....................................................32.18

(2) Miscellaneous Lens Items.

Z3158Balance lens..........................50 percent of allowance for comparable single vision lens
Z31604.00-6.00 diopter, cylinder....................................................$1.81
Z3162Prism (if available from stock blank)....................................................4.22
Z3164Bifocal--adds 4.00 diopter or higher....................................................13.00
Z3166Absorptive characteristics....................................................By Report
Z3168Higher powers than listed (per diopter)....................................................2.48
Z3170Slab-off....................................................26.00
Z3172Fresnel prism....................................................11.05

(3) Frames.

Z3174Frame--zyl....................................................$9.50
Z3176Frame--(metal only)....................................................16.20
Z3178Arm with adjustable pad....................................................3.75
Z3180Front--zyl (replace supplied frames)....................................................4.80
Z3182Front--metal only (replace supplied frames)....................................................10.40
Z3184Temple--(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).