Summary
This is a reissue of MA07.029e with no substantive changes to coverage criteria for refractive lenses. The policy was reissued on 12/19/2025 as part of Independence Blue Cross's annual review process. One HCPCS code (V2526 - Contact lens with blue-violet filter) was added effective 10/01/2023, which remains the only material update to the policy since its 01/01/2024 effective date for New Jersey Medicare Advantage plans.
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What to do
Action · 5 steps
01No action required.
02This is a routine annual policy reissue with no changes to coverage criteria, medical necessity definitions, or billing requirements.
03The policy remains in effect for New Jersey Medicare Advantage plans as originally published on 01/01/2024.
04Billing teams should verify that systems already account for HCPCS code V2526 (added 10/01/2023) if billing contact lenses with blue-violet filters.
05Standard refractive lens coverage criteria for aphakia and pseudophakia remain unchanged.
Codes mentioned
V2020V2100V2101V2102V2103V2104V2526V2744V2745V2750V2755V2780V2784S0580H26.40H27.00H27.01H27.02H27.03Q12.3Z96.1Z98.41Z98.42Z98.49
Original notice
MA07.029e, Refractive Lenses
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →Related policy hubs
Independence Blue Cross policiesNJ policy changesOphthalmologyOptometryCode V2020Code V2100Code V2101Code V2102Code V2103Code V2104Code V2526Code V2744Code V2745Code V2750Code V2755Code V2780Code V2784Code S0580Code H26.40Code H27.00Code H27.01Code H27.02Code H27.03Code Q12.3Code Z96.1Code Z98.41Code Z98.42Code Z98.49