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Reimbursement schedule
- The provider (or in the case of direct reimbursement, the member) shall receive payment of the usual and customary charge or up to $125.00, whichever is less, from the Fund for a complete service which includes single vision, bifocal or trifocal lenses, a basic frame and eye exam.
- The provider (or in the case of direct reimbursement, the member) shall receive payment from the Fund of the usual and customary charge or up to $125.00, whichever is less, for any partial service rendered. A partial service includes only a frame or lenses.
- The provider (or in the case of direct reimbursement, the member) shall receive payment from the Fund of $20.00 for an eye exam only.
Note: If mandated by state law, panelists outside of New York State are allowed to charge the member the difference between the mandated price and our fee schedule.
- The provider (or in the case of direct reimbursement, the member) shall receive payment of $125.00 from the Fund towards the purchase of contact lenses. The member/patient is responsible for the balance.