Supported Payers and Coding - Anagram API Docs

Supported Payers

Payer	API code	In-Network Mode	Out-of-Network Mode
VSP	`insurer:vision:vsp`	✅	✅
EyeMed	`insurer:vision:eye_med`	✅	✅
Spectera	`insurer:vision:spectera`	✅	✅
Davis Vision	`insurer:vision:davis_vision`	✅	✅
Superior Vision	`insurer:vision:superior`	✅	✅
Anagram Vision Demo Payer	`insurer:demo:vision`	✅	✅
Aetna Vision	`insurer:vision:aetna_vision`	✅	✅
NVA	`insurer:vision:nva`	✅	❌
VBA	`insurer:vision:vba`	✅	❌
Avesis	`insurer:vision:avesis`	✅	❌
Cigna Vision	`insurer:vision:cigna_vision` (deprecated) use `insurer:vision:vsp` instead	✅	✅
Blue View	`insurer:vision:blue_view` (deprecated) use `insurer:vision:eye_med` instead	✅	✅

VSP

Insurer code: insurer:vision:vsp

Features:

supports claim submission using member ID (subscription ID) or SSN last four

Additional claim constraints:

patient and primary member sex must be provided
diagnosis must be provided

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015, S0620, S0621	medical examination and evaluation
92071, 92072, 92310, 92314	contact lens fit
S0500	contact lens
V2020, V2025	frames
V21##	Sphere, single vision lens
V22##	Sphere, bifocal lens
V23##	Sphere, trifocal lens
V24##	asphericity lens
V25##	contact lens
V27##	add-ons

Note that although the VSP claim form allows arbitrary CPT/HCPCS codes and our API supports the majority of them, we recommend using only the codes specified above to reduce the chance of claim rejections. Contact Anagram customer support if you need to use other codes.

Anagram Vision Demo

The Anagram Vision Demo insurer should be used for testing only. It does not interface with real insurance companies.

Insurer code: insurer:demo:vision
Claim form: out-of-network claim form

Features:

supports claim submission using member ID (subscription ID) or SSN last four

We recommend using the same service types as VSP.

Eyemed

Insurer code: insurer:vision:eye_med

Features:

supports claim submission using member ID (subscription ID)

Additional claim constraints:

member id of the primary member must be provided
patient member id must be provided if type is not self

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015, 92015-TG, 92225, 92226, 92230, 92250, 92260, 92265, S0592, S0620, S0621	Medical examination and evaluation
92071, 92072, 92310, 92310-21, 92310-22, 92314	Contact lens fit
S0500, S0512, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599, V2627	Contact lens
V2020, V2025, S0516, S0518	Frames
S0504, V2100. V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2410	Sphere, single vision lens
S0506, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299	Sphere, bifocal lens
S0508, V2300, V2301, V2302, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399	Sphere, trifocal lens
V2410, V2430, V2499	Variable asphericity lens
V2781, S0581, V2781-26	Progressive lens
V2760, V2745, V2755	Add-ons

Spectera

Insurer code: insurer:vision:spectera

Features:

supports claim submission using member ID (subscription ID)

Additional claim constraints:

member id of primary member must be provided

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015, 92015-TG, 92225, 92226, 92230, 92250, 92260, 92265, S0592, S0620, S0621	Medical examination and evaluation
92071, 92072, 92310, 92310-21, 92310-22, 92314	Contact lens fit
S0500, S0512, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599, V2627	Contact lens
V2020, V2025, S0516, S0518	Frames
S0504, V2100. V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2410	Sphere, single vision lens
S0506, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299	Sphere, bifocal lens
S0508, V2300, V2301, V2302, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399	Sphere, trifocal lens
V2410, V2430, V2499	Variable asphericity lens
V2781, S0581, V2781-26	Progressive lens
V2760, V2761, V2744, V2745	Coating
V2744	Photochromatic
V2755	UV Lens

Davis Vision

Insurer code: insurer:vision:davis_vision

Features:

supports claim submission using member ID (subscription ID)

Additional claim constraints:

member id of primary member must be provided

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015, 92015-TG, 92225, 92226, 92230, 92250, 92260, 92265, S0592, S0620, S0621	Medical examination and evaluation
92071, 92072, 92310, 92310-21, 92310-22, 92314	Contact lens fit
S0500, S0512, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599, V2627	Contact lens
V2020, V2025, S0516, S0518	Frames
S0504, V2100. V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2410	Sphere, single vision lens
S0506, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299	Sphere, bifocal lens
S0508, V2300, V2301, V2302, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399	Sphere, trifocal lens

Cigna Vision

Insurer code: insurer:vision:cigna_vision

Features:

supports claim submission using member ID (subscription ID) or SSN last four

Additional claim constraints:

patient/primary member sex must be provided
diagnosis must be provided

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015, S0620, S0621	medical examination and evaluation
92071, 92072, 92310, 92314	contact lens fit
S0500	contact lens
V2020, V2025	frames
V21##	Sphere, single vision lens
V22##	Sphere, bifocal lens
V23##	Sphere, trifocal lens
V24##	asphericity lens
V25##	contact lens
V27##	add-ons

Aetna Vision

Insurer code: insurer:vision:aetna_vision

Features:

supports claim submission using member ID (subscription ID)

Additional claim constraints:

member id of primary member must be provided
patient member id must be provided if type is not self

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015, 92015-TG, 92225, 92226, 92230, 92250, 92260, 92265, S0592, S0620, S0621	Medical examination and evaluation
92071, 92072, 92310, 92310-21, 92310-22, 92314	Contact lens fit
S0500, S0512, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599, V2627	Contact lens
V2020, V2025, S0516, S0518	Frames
S0504, V2100. V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2410	Sphere, single vision lens
S0506, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299	Sphere, bifocal lens
S0508, V2300, V2301, V2302, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399	Sphere, trifocal lens
V2410, V2430, V2499	Variable asphericity lens
V2781, S0581, V2781-26	Progressive lens
V2760, V2745, V2755	Add-ons

Blue View

Insurer code: insurer:vision:blue_view

Features:

supports claim submission using member ID (subscription ID)

Additional claim constraints:

member id of primary member must be provided
patient member id must be provided if type is not self

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015, 92015-TG, 92225, 92226, 92230, 92250, 92260, 92265, S0592, S0620, S0621	Medical examination and evaluation
92071, 92072, 92310, 92310-21, 92310-22, 92314	Contact lens fit
S0500, S0512, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599, V2627	Contact lens
V2020, V2025, S0516, S0518	Frames
S0504, V2100. V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2410	Sphere, single vision lens
S0506, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299	Sphere, bifocal lens
S0508, V2300, V2301, V2302, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399	Sphere, trifocal lens
V2410, V2430, V2499	Variable asphericity lens
V2781, S0581, V2781-26	Progressive lens
V2760, V2745, V2755	Add-ons

Superior

Insurer code: insurer:vision:superior

Additional claim constraints:

member id of primary member must be provided

List of recommended CPT/HCPCS codes:

Codes	Description
92002, 92004, 92012, 92014, 92015-TG, S0592, S0620, S0621	Medical examination and evaluation
92310, 92314, S0592	Contact lens fit
V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599	Contact lens
V2020, V2025, S0516, S0518	Frames
V2100, V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2410	Sphere, single vision lens
V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299, V2430	Sphere, bifocal lens
V2300, V2301, V2302, V2303, V2304, V2305, V2306, V2307, V2308, V2309, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399	Sphere, trifocal lens
V2781	Progressive lens
V2700, V2702, V2710, V2715, V2718, V2730, V2744, V2745, V2750, V2755, V2756, V2760, V2762, V2770, V2780, V2782, V2783, V2784, V2785, V2786, V2787, V2788, V2790, V2797, V2799	Add-ons
V2115, V2121, V2215, V2221, V2315, V2321, V2410, V2430	Other (Lens)
V2744, V2745, V2755, V2760, V2799, S0580	Other (Coating)
V2799, S0580, S0581	Other

Frequently used ICD10 codes

Code	Description
H04.121	Dry eye syndrome of right lacrimal gland (H04.121)
H04.122	Dry eye syndrome of left lacrimal gland (H04.122)
H04.123	Dry eye syndrome of bilateral lacrimal glands (H04.123)
H04.129	Dry eye syndrome of unspecified lacrimal gland (H04.129)
H11.151	Pinguecula, right eye (H11.151)
H11.152	Pinguecula, left eye (H11.152)
H11.153	Pinguecula, bilateral (H11.153)
H11.159	Pinguecula, unspecified eye (H11.159)
H25.011	Cortical age-related cataract, right eye (H25.011)
H25.012	Cortical age-related cataract, left eye (H25.012)
H25.013	Cortical age-related cataract, bilateral (H25.013)
H25.019	Cortical age-related cataract, unspecified eye (H25.019)
H44.20	Degenerative myopia, unspecified eye (H44.20)
H44.21	Degenerative myopia, right eye (H44.21)
H44.22	Degenerative myopia, left eye (H44.22)
H44.23	Degenerative myopia, bilateral (H44.23)
H52.00	Hypermetropia, unspecified eye (H52.00)
H52.01	Hypermetropia, right eye (H52.01)
H52.02	Hypermetropia, left eye (H52.02)
H52.03	Hypermetropia, bilateral (H52.03)
H52.10	Myopia, unspecified eye (H52.10)
H52.11	Myopia, right eye (H52.11)
H52.12	Myopia, left eye (H52.12)
H52.13	Myopia, bilateral (H52.13)
H52.201	Unspecified astigmatism, right eye (H52.201)
H52.202	Unspecified astigmatism, left eye (H52.202)
H52.203	Unspecified astigmatism, bilateral (H52.203)
H52.209	Unspecified astigmatism, unspecified eye (H52.209)
H52.211	Irregular astigmatism, right eye (H52.211)
H52.212	Irregular astigmatism, left eye (H52.212)
H52.213	Irregular astigmatism, bilateral (H52.213)
H52.219	Irregular astigmatism, unspecified eye (H52.219)
H52.221	Regular astigmatism, right eye (H52.221)
H52.222	Regular astigmatism, left eye (H52.222)
H52.223	Regular astigmatism, bilateral (H52.223)
H52.229	Regular astigmatism, unspecified eye (H52.229)
H52.31	Anisometropia (H52.31)
H52.32	Aniseikonia (H52.32)
H52.4	Presbyopia (H52.4)
H52.6	Other disorders of refraction (H52.6)
H52.7	Unspecified disorder of refraction (H52.7)
Z01.00	Encounter for examination of eyes and vision without abnormal findings (Z01.00)
Z01.01	Encounter for examination of eyes and vision with abnormal findings (Z01.01)
Z46.0	Encounter for fitting and adjustment of spectacles and contact lenses (Z46.0)