The patient’s chief complaint and the history of present illness are primary factors used to determine the appropriate service level and billing classification.

• When a patient schedules an appointment for an annual exam and does not report any additional symptoms or medical concerns, the encounter should be billed as a WellVision^® Eye Exam.
• If the patient’s chief complaint is an annual eye exam and pathology or an ocular medical condition is identified during the visit, additional testing or procedures, beyond those included in a VSP WellVision^® Exam, may be needed.
  • If you determine that any portion of the services should be submitted to the patient’s medical insurance plan, you must clearly disclose to the patient the reason and include that services may be subject to deductibles, out-of-pocket costs, or other patient financial liabilities.
  • Review the patient’s eligibility for Essential Medical Eye Care. This benefit may cover subsequent visits, diagnostic testing, and treatment related to the identified condition and may be submitted to VSP when applicable.

For additional related information, refer to the Essential Medical Eye Care and Coordination of Benefits (Determining and Applying Benefits > Common Scenarios: Routine vs. Medical Services) sections of the VSP Provider Reference Manual.