Ambetter · PayerPolicy · AMBETTER-CP-VP-13-ATTACHMENT-A-REFRACTIVE-HARDWARE
Summary of the payer’s published policy. Not a coverage determination — confirm with Ambetter before submitting.
Free account. Policy pages stay open to everyone.
Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
| Code | Code system | Status in this policy |
|---|---|---|
| 92310 | CPT | Covered |
| 92311 | CPT | Covered |
| 92312 | CPT | Covered |
| 92313 | CPT | Covered |
| 92314 | CPT | Covered |
| 92315 | CPT | Covered |
| 92316 | CPT | Covered |
| 92317 | CPT | Covered |
| 92325 | CPT | Covered |
| 92326 | CPT | Covered |
| 92340 | CPT | Covered |
| 92341 | CPT | Covered |
| 92342 | CPT | Covered |
| 92370 | CPT | Covered |
| S0500 | HCPCS | Covered |
| V2020 | HCPCS | Covered |
| V2025 | HCPCS | Covered |
|---|
| V2100 | HCPCS | Covered |
|---|
| V2101 | HCPCS | Covered |
|---|
| V2102 | HCPCS | Covered |
|---|
| V2103 | HCPCS | Covered |
|---|
| V2104 | HCPCS | Covered |
|---|
| V2105 | HCPCS | Covered |
|---|
| V2106 | HCPCS | Covered |
|---|
| V2107 | HCPCS | Covered |
|---|
| V2108 | HCPCS | Covered |
|---|
| V2109 | HCPCS | Covered |
|---|
| V2110 | HCPCS | Covered |
|---|
| V2111 | HCPCS | Covered |
|---|
| V2112 | HCPCS | Covered |
|---|
| V2113 | HCPCS | Covered |
|---|
| V2114 | HCPCS | Covered |
|---|
| V2115 | HCPCS | Covered |
|---|
| V2118 | HCPCS | Covered |
|---|
| V2121 | HCPCS | Covered |
|---|
| V2199 | HCPCS | Covered |
|---|
| V2200 | HCPCS | Covered |
|---|
| V2201 | HCPCS | Covered |
|---|
| V2202 | HCPCS | Covered |
|---|
| V2203 | HCPCS | Covered |
|---|
| V2204 | HCPCS | Covered |
|---|
| V2205 | HCPCS | Covered |
|---|
| V2206 | HCPCS | Covered |
|---|
| V2207 | HCPCS | Covered |
|---|
| V2208 | HCPCS | Covered |
|---|
| V2209 | HCPCS | Covered |
|---|
| V2210 | HCPCS | Covered |
|---|
| V2211 | HCPCS | Covered |
|---|
| V2212 | HCPCS | Covered |
|---|
| V2213 | HCPCS | Covered |
|---|
| V2214 | HCPCS | Covered |
|---|
| V2215 | HCPCS | Covered |
|---|
| V2218 | HCPCS | Covered |
|---|
| V2219 | HCPCS | Covered |
|---|
| V2220 | HCPCS | Covered |
|---|
| V2221 | HCPCS | Covered |
|---|
| V2299 | HCPCS | Covered |
|---|
| V2300 | HCPCS | Covered |
|---|
| V2301 | HCPCS | Covered |
|---|
| V2302 | HCPCS | Covered |
|---|
| V2303 | HCPCS | Covered |
|---|
| V2304 | HCPCS | Covered |
|---|
| V2305 | HCPCS | Covered |
|---|
| V2306 | HCPCS | Covered |
|---|
| V2307 | HCPCS | Covered |
|---|
| V2308 | HCPCS | Covered |
|---|
| V2309 | HCPCS | Covered |
|---|
| V2310 | HCPCS | Covered |
|---|
| V2311 | HCPCS | Covered |
|---|
| V2312 | HCPCS | Covered |
|---|
| V2313 | HCPCS | Covered |
|---|
| V2314 | HCPCS | Covered |
|---|
| V2315 | HCPCS | Covered |
|---|
| V2318 | HCPCS | Covered |
|---|
| V2319 | HCPCS | Covered |
|---|
| V2320 | HCPCS | Covered |
|---|
| V2321 | HCPCS | Covered |
|---|
| V2399 | HCPCS | Covered |
|---|
| V2410 | HCPCS | Covered |
|---|
| V2430 | HCPCS | Covered |
|---|
| V2499 | HCPCS | Covered |
|---|
| V2500 | HCPCS | Covered |
|---|
| V2501 | HCPCS | Covered |
|---|
| V2502 | HCPCS | Covered |
|---|
| V2503 | HCPCS | Covered |
|---|
| V2510 | HCPCS | Covered |
|---|
| V2511 | HCPCS | Covered |
|---|
| V2512 | HCPCS | Covered |
|---|
| V2513 | HCPCS | Covered |
|---|
| V2520 | HCPCS | Covered |
|---|
| V2521 | HCPCS | Covered |
|---|
| V2522 | HCPCS | Covered |
|---|
| V2523 | HCPCS | Covered |
|---|
| V2524 | HCPCS | Covered |
|---|
| V2525 | HCPCS | Covered |
|---|
| V2526 | HCPCS | Covered |
|---|
| V2530 | HCPCS | Covered |
|---|
| V2531 | HCPCS | Covered |
|---|
| V2599 | HCPCS | Covered |
|---|
| V2700 | HCPCS | Covered |
|---|
| V2702 | HCPCS | Covered |
|---|
| V2710 | HCPCS | Covered |
|---|
| V2715 | HCPCS | Covered |
|---|
| V2718 | HCPCS | Covered |
|---|
| V2730 | HCPCS | Covered |
|---|
| V2744 | HCPCS | Covered |
|---|
| V2745 | HCPCS | Covered |
|---|
| V2750 | HCPCS | Covered |
|---|
| V2755 | HCPCS | Covered |
|---|
| V2760 | HCPCS | Covered |
|---|
| V2761 | HCPCS | Covered |
|---|
| V2762 | HCPCS | Covered |
|---|
| V2770 | HCPCS | Covered |
|---|
| V2780 | HCPCS | Covered |
|---|
| V2781 | HCPCS | Covered |
|---|
| V2782 | HCPCS | Covered |
|---|
| V2783 | HCPCS | Covered |
|---|
| V2784 | HCPCS | Covered |
|---|
| V2786 | HCPCS | Covered |
|---|
| H52.00 | ICD10CM | Covered |
|---|
| H52.01 | ICD10CM | Covered |
|---|
| H52.02 | ICD10CM | Covered |
|---|
| H52.03 | ICD10CM | Covered |
|---|
| H52.10 | ICD10CM | Covered |
|---|
| H52.11 | ICD10CM | Covered |
|---|
| H52.12 | ICD10CM | Covered |
|---|
| H52.13 | ICD10CM | Covered |
|---|
| H52.201 | ICD10CM | Covered |
|---|
| H52.202 | ICD10CM | Covered |
|---|
| H52.203 | ICD10CM | Covered |
|---|
| H52.209 | ICD10CM | Covered |
|---|
| H52.211 | ICD10CM | Covered |
|---|
| H52.212 | ICD10CM | Covered |
|---|
| H52.213 | ICD10CM | Covered |
|---|
| H52.219 | ICD10CM | Covered |
|---|
| H52.221 | ICD10CM | Covered |
|---|
| H52.222 | ICD10CM | Covered |
|---|
| H52.223 | ICD10CM | Covered |
|---|
| H52.229 | ICD10CM | Covered |
|---|
| H52.31 | ICD10CM | Covered |
|---|
| H52.32 | ICD10CM | Covered |
|---|
| H52.4 | ICD10CM | Covered |
|---|
| H52.521 | ICD10CM | Covered |
|---|
| H52.522 | ICD10CM | Covered |
|---|
| H52.523 | ICD10CM | Covered |
|---|
| H52.529 | ICD10CM | Covered |
|---|
| H52.531 | ICD10CM | Covered |
|---|
| H52.532 | ICD10CM | Covered |
|---|
| H52.533 | ICD10CM | Covered |
|---|
| H52.539 | ICD10CM | Covered |
|---|
| H53.011 | ICD10CM | Covered |
|---|
| H53.012 | ICD10CM | Covered |
|---|
| H53.013 | ICD10CM | Covered |
|---|
| H53.019 | ICD10CM | Covered |
|---|
| H53.021 | ICD10CM | Covered |
|---|
| H53.022 | ICD10CM | Covered |
|---|
| H53.023 | ICD10CM | Covered |
|---|
| H53.029 | ICD10CM | Covered |
|---|
| H53.031 | ICD10CM | Covered |
|---|
| H53.032 | ICD10CM | Covered |
|---|
| H53.033 | ICD10CM | Covered |
|---|
| H53.039 | ICD10CM | Covered |
|---|
| Z01.01 | ICD10CM | Covered |
|---|
| Z46.0 | ICD10CM | Covered |
|---|