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December 2016 Texas Medicaid Provider Procedures Manual

Vision and HearingServices Handbook : 4 Vision Care Professionals : 4.3 Services, Benefits, Limitations, and Prior Authorization : 4.3.7 Vision Services for Prosthetic Eyewear : Ultraviolet (U-V) Protection
Procedure code V2755 may be reimbursed for U-V protection when billed with one of the following diagnosis codes:
UV lens procedure code V2755 will be denied when billed with the same date of service by the same provider as polycarbonate lens procedure code V2784.
UV and polycarbonate lens procedure codes are subject to CMS NCCI relationships.
Refer to:
The CMS NCCI web page for the published correct coding guidelines and specific applicable code combinations.

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