MedicaidCoverageMedium impact
Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 25 (Optometrist) and 41 (Optician, Optical Business): Billing Instructions for Combining Lens-Related Vision Codes
Nevada Medicaid·NV · Ophthalmology, Optometry·Billing & Coding
Effective date
Nov 1, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has established new billing limitations for lens-related vision codes, restricting bifocal/trifocal width codes and prism add-on codes to 2 units per rolling year each, with treatment and coating codes having individual 2-unit limits. Claims previously denied with error code 5585 will be automatically reprocessed.
Action Required
Immediately: Billing team must update system to track rolling year limits for vision lens codes - maximum 2 combined units per year for bifocal/trifocal width codes (V2219, V2220, V2319, V2320), maximum 2 combined units per year for prism codes (V2710, V2715, V2718), and maximum 2 units per year for each individual treatment/coating code (V2730, V2745, V2750, V2755, V2760). Configure system to request prior authorization when limits are exceeded. Monitor remittance advices for automatically reprocessed claims that were previously denied with error code 5585.