Ordering Medically Necessary Contact Lenses with VSP

The VSP integration allows you to create orders and submit VSP claims for medically necessary contact lenses.

VSP requires that the patient’s most recent eyeglass prescription be included when you create medically necessary contact lens orders. Claims must meet this and all other VSP requirements for medically necessary contact lenses, or they will fail.

Some conditions that qualify include:

  • Anisometropia greater than or equal to 3.00 diopters difference, based on the eyeglass prescription

  • High ametropia greater than or equal to 10.00 diopters in either eye, based on the eyeglass prescription

For a list of all VSP's requirements for covering medically necessary contact lenses, see the Contact Lens Benefits section of the VSP Provider Reference Manual on VSP Online. Go to Finding VSP Reference Information for steps to access the manual.

To order medically necessary contact lenses with VSP:

  1. On the left side of the Demographics screen, perform one of the following steps:
    • Click Material Orders and then, under Create an Order, click Add Contact Lens Order.
    • Click Contact Lens Order.
  2. Locate the VSP plan and click + VSP Order.

    A green icon next to Contact indicates that the patient has a valid contact lens authorization.

  3. Click a prescription in the Choose an Rx list.

    The prescription information panel opens.

  4. Enter the quantity of each lens that you want to order.
  5. Select the Medically Necessary Lenses check box.

    The Confirm Eyeglass Rx window opens, displaying information from the patient’s most recent valid eyeglass prescription. If none is found in the system, the fields are blank.

  6. If necessary, edit or enter the Sphere, Cylinder, and Axis information.
  7. Click Use This Rx.
  8. Click + Add to Order.

    The Order Summary opens. If you need to change your selections, you can deselect the Medically Necessary Lenses check box or edit the eyeglass prescription information by clicking the See Eyelass Rx hyperlink.

    The Estimated Charges area of the summary shows that the entire cost (minus co-pay, if any) is covered by VSP. Proceed as you normally would to complete a contact lens order.