Visually Necessary Contact Lenses

Beginning June 1, 2024, VSP^® will implement new criteria that requires an improvement in best corrected visual acuity (BCVA) by two lines, compared to spectacles for Visually Necessary Contact Lenses (VNCL) specialty conditions.  

This implementation will not change how VNCL claims are submitted to VSP.  

Starting June 1, 2024, BCVA findings for specialty conditions must be recorded on the patient’s medical exam records and attest to a two-line improvement compared to spectacles and are subject to review and audit. 

Specialty conditions and the accompanying diagnostic codes that require an improvement in BCVA by two lines compared to spectacles are provided in the Contact Lens Benefit section of the Provider Reference Manual, in the “Visually Necessary Specialty Contact Lenses” section. The BCVA requirement does not apply to high ametropia, anisometropia, or nystagmus.

For additional coverage information, visit the Provider Reference Manual by logging into eyefinity.com and selecting VSPOnline. Once logged in, select the Manuals option on the left side of the page and click the VSP network. The Contact Lens Benefit section will provide the contact lens benefit information. This information can also be accessed from the Materials Coverage section of the Choice and Advantage network.