OPTICAL CODES PAYING ON INCORRECT FEE SCHEDULE

Date: 08/05/22

Meridian identified specific vision codes reimbursing opticians at an incorrect fee schedule. The error caused claims to be paid over the published HFS fee schedule rate. This impacts HCI, YouthCare and MMAI claims. Currently, claims for the following CPT codes are reimbursed from the practitioner fee schedule when billed by an optician: 92015, 92340, 92341, and 92370.

Meridian will NOT be recouping any claims paid at the practitioner fee schedule rate. For claims received or adjusted on or after September 1, 2022, Meridian will make corrections to reimburse the following codes per the optician fee schedule. Ophthalmologists will continue to be reimbursed at the practitioner fee schedule rates. 

Procedure Code	Practitioner Fee Schedule	Optician Fee Schedule
92015	$18.45	$17.95
92340	$30.07	$29.28
92341	$30.07	$29.28
92370	$4.76	$4.63

If you have any questions, please contact Provider Services at 866-606-3700 (TTY 711). To review the HFS fee schedules, please visit Medicaid Reimbursement | HFS (illinois.gov).