There are several big changes effective June 1: a) contact lens formulary changes, b) all contact lens claims must have a modifier, and c) the private label equivalents of formulary contacts must be submitted as covered contacts.
CL Added to the Formulary:
- Acuvue Oasys
- Dailies Aqua Comfort Plus, Focus Dailies Toric, Dailies Progressive, ProClear 1-Day and Acuvue One-Day Moist. Note: These are 30-pack boxes, NOT 90-pack boxes.
Remove from Formulary:
- Bausch & Lomb Pure Vision
New Requirement: All private label versions of formulary lenses must be submitted as Covered Contact Lenses.
New Requirement: A contact lens modifier must be submitted on all contact lens claims. There is a short transition period to give providers time to change their processes internally. Use the modifiers beginning June 1. Starting July 1, contact claims without a modifier will be rejected.
A June 1 contact lens formulary is attached for reference; it will be available online beginning June 1. The current modifier is also attached for reference.