FAQ: What Can I Expect to Be Reimbursed for Contact Lens Fitting Fees?

Answer: 
Providers receive 85% of their usual and customary (U&C) fee for a contact lens exam (fitting and evaluation). The portion that is paid between the patient and VSP^® can vary depending on the patient’s vision care plan, but when combined, regardless of the plan, it is 85% of U&C. 

The “initial” contact lens fitting period for all contact lens benefits is 90 days. Any additional or excluded (e.g., CRT, Ortho-K, and myopia management) contact lens fitting services should be handled privately between you and the patient. Contact lens insertion and removal training services are not separately reimbursed.

Contact Lens Exam Copay with Materials Allowance: Patients who request a contact lens exam pay a contact lens exam copay or 85% of your U&C fees, whichever is less. There is no copay for contact lens materials, which are covered under a separate allowance.

• Example 1: Patient has a $60 contact lens copay, and your U&C fee is $60. Since 85% of your U&C fee ($51) is less than the $60 copay, you would only charge $51 (85% of U&C). 
• Example 2: Patient has a $60 contact lens copay, and your U&C fee is $80. Since 85% of your U&C fee ($68) is greater than the $60 copay, you would collect the $60 copay from the patient, and VSP would pay the remaining $8. 

In both examples, you receive 85% of your U&C fee while helping patients take advantage of vision care benefits that can make contact lenses more affordable and accessible. This can create additional opportunities to build long-term patient relationships and support better visual outcomes.

Want more information? Register or log in to UUniversity™ to access the free, on-demand course, “Billing Best Practices: Contact Lenses,” part of the “Billing Best Practices” curriculum.  

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