Cal. Code Regs. tit. 22, § 51519.2 – Reimbursement Rates for Ophthalmic Appliances Supplied by a Fabricating Optical Laboratory Under an Exclusive Area Negotiated Contract.

(a) General Provisions.
1. (1) Reimbursement rates listed in (b) below include lens grinding, cutting, edging, impact resistance and testing, oversize lenses, special beveling, drilling and mounting.
2. (2) “Diopters” refers to the power of the strongest meridian of the major portion of the lens, the maximum cylindrical power, or the power of the segment addition, as appropriate.
(b) Maximum reimbursement rates payable under an exclusive area negotiated contract for eye appliances shall be as follows:
1. (1) Spectacle Lenses.
  Procedure Code
  Maximum Reimbursement Rates per Lens
  SINGLE VISION GLASS
  Z3100
  0.00-4.00 diopters
  $ 7.34
  Z3102
  4.12-7.00 diopters
  7.68
  Z3104
  7.12-20.00 diopters
  19.79
  Z3106
  Lenticular
  28.44
  BIFOCAL GLASS
  Z3108
  0.00-4.00 diopters
  $10.95
  Z3110
  4.12-7.00 diopters
  12.60
  Z3112
  7.12-20.00 diopters
  21.60
  Z3114
  Lenticular
  40.14
  TRIFOCAL GLASS
  Z3116
  0.00-4.00 diopters
  $15.65
  Z3118
  4.12-7.00 diopters
  16.94
  SINGLE VISION PLASTIC
  Z3120
  0.00-4.00 diopters
  $8.32
  Z3122
  4.12-6.00 diopters
  9.56
  Z3124
  6.12-10.00 diopters
  12.43
  Z3126
  10.12-14.00 diopters
  15.00
  Z3128
  14.12-18.00 diopters
  15.00
  Z3130
  Aspheric (lenticular or full field)
  28.60
  Z3132
  Lenticular, nonaspheric, plus
  26.65
  Z3134
  Lenticular, nonaspheric, minus
  32.30
  BIFOCAL PLASTIC
  Z3136
  0.00-4.00 diopters
  $13.04
  Z3138
  4.12-6.00 diopters
  15.32
  Z3140
  6.12-10.00 diopters
  18.01
  Z3142
  10.12-14.00 diopters
  28.92
  Z3144
  14.12-18.00 diopters
  28.92
  Z3146
  Aspheric (lenticular or full field)
  46.15
  Z3148
  Lenticular, nonaspheric, plus
  31.20
  Z3150
  Lenticular, nonaspheric, minus
  35.42
  TRIFOCAL PLASTIC
  Z3152
  0.00-4.00 diopters
  $20.15
  Z3154
  4.12-7.75 diopters
  22.17
  Z3156
  8.00-14.00 diopters
  32.18
2. (2) Miscellaneous Lens Items.
  Z3158
  Balance lens
  50 percent of allowance for comparable single vision lens
  Z3160
  4.00-6.00 diopter, cylinder
  $1.81
  Z3162
  Prism (if available from stock blank)
  4.22
  Z3164
  Bifocal--adds 4.00 diopter or higher
  13.00
  Z3166
  Absorptive characteristics
  By Report
  Z3168
  Higher powers than listed (per diopter)
  2.48
  Z3170
  Slab-off
  26.00
  Z3172
  Fresnel prism
  11.05
3. (3) Frames.
  Z3174
  Frame--zyl
  $9.50
  Z3176
  Frame--(metal only)
  16.20
  Z3178
  Arm with adjustable pad
  3.75
  Z3180
  Front--zyl (replace supplied frames)
  4.80
  Z3182
  Front--metal only (replace supplied frames)
  10.40
  Z3184
  Temple--(replace supplied frames)
  2.35

Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code; and Section 87, Chapter 1594, Statutes of 1982. Reference: Sections 14105.3 and 14132, Welfare and Institutions Code.

History

1. New section filed 11-28-88 as an emergency; operative 11-28-88 (Register 89, No. 11). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-28-89.

2. Certificate of Compliance as to 11-28-88 order transmitted to OAL 3-27-89 and filed 4-26-89 (Register 89, No. 18).

3. Amendment of section heading and subsections (b)(1)-(b)(3) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 9-25-92 order including amendment of subsection (b)(3) transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).

5. Amendment of subsections (a) and (b) and new Note filed 10-1-92 with Secretary of State by Department of Health Services; operative 10-1-92. Submitted to OAL for printing only pursuant to section 147(c), SB 485, (Chapter 722, Statutes of 1992) (Register 92, No. 40).