VSP Signature Plan® Lens Enhancements Chart
Effective July 1, 2018
Use this chart to determine what to charge patients and reconcile your VSP® Vision Care Explanation of Payment.
Copay
All lens enhancements are covered after a copay. Charge patient the listed copay or your usual and customary fee (U&C), whichever is lower.
Charge Back
This is the amount charged to you for lab fees. You won’t be charged for covered lens enhancements.
Service Fee
You’ll receive the listed service fee. VSP will reimburse this fee for covered lens enhancements. For other enhancements, this will be included in the copay you collect from the patient.

VSP Signature Plan
Charge patients the listed patient copay or your U&C fee, whichever is lower.
Effective July 1, 2018
Aspherical and Spherical Lens Styles
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
AA
Aspheric Plastic 1.50
$10
$13
$23
$14
$14
$28
AB
High-index Plastic 1.53-1.60/Trivex
$29
$22
$51
$33
$22
$55
AH
High-index Plastic 1.66/1.67
$48
$28
$76
$58
$32
$90
AJ
High-index Plastic 1.70 & Above
$68
$34
$102
--
--
--
AD
Polycarbonate
$10
$13
$23
$14
$14
$28
AE
(Lab Use Only)
--
--
--
--
--
--
AF
High-index Glass 1.60–1.80 (Clear)
$35
$20
$55
$85
$42
$127
Digital Aspheric Lens Styles
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
BA
Digital Aspheric Lenses – Plastic
$19
$14
$33
$26
$14
$40
BA+BB
Digital Aspheric Lenses – High-index Plastic 1.53-1.60/Trivex
$16
$11
$33 + $27
$16
$11
$40 + $27
BA+BH
Digital Aspheric Lenses – High-index Plastic 1.66/1.67
$37
$19
$33 + $56
$40
$25
$40 + $65
BA+BJ
Digital Aspheric Lenses – High-index Plastic 1.70 & Above
$57
$25
$33 + $82
--
--
--
BD
Digital Aspheric Lenses – Polycarbonate
$19
$14
$33
$26
$14
$40
Occupational Lens Styles
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
CA
(Lab Use Only)
--
--
--
--
--
--
CE
(Lab Use Only)
--
--
--
--
--
--
Polarized Lens Styles
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
DA
Polarized Lenses – Plastic A
$36
$17
$53
$48
$23
$71
DA + DB
Polarized Lenses – High-index Plastic 1.53-1.60/Trivex
$47
$23
$53 + $70
$59
$29
$71 + $88
DA + DH
Polarized Lenses – High-index Plastic 1.66/1.67
$55
$27
$53 + $82
--
--
--
DA + DD
Polarized Lenses – Polycarbonate
$13
$14
$53 + $27
$13
$14
$71 + $27
DE
Polarized/Laminated Lenses – Glass
$49
$23
$72
$63
$30
$93
Bifocal Lens Styles (Mark bifocal box.)
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
IA
Near Variable Focus – Plastic
--
--
--
$26
$20
$46
IA + IB
Near Variable Focus – High-index Plastic 1.53-1.60
--
--
--
$11
$10
$46 + $21
IA + II
Near Variable Focus – High-index Plastic 1.66/1.67
--
--
--
$27
$18
$46 + $45
IA + ID
Near Variable Focus – Polycarbonate
--
--
--
$7
$10
$46 + $17
GA
Blended Bifocal – Plastic
--
--
--
$14
$13
$27
Plastic Dyes
Single Vision
--
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge
Back
Service Fee
Patient Copay
MM
(Lab Use Only)
--
--
--
--
--
MN
Plastic Dyes – Solid Color (Except Pink I & II)
$5
$8
$13
$5
$8
$13
MP
Plastic Dyes – Gradient
$7
$8
$15
$7
$8
$15
+This lens enhancement code is always in conjunction with a base lens enhancement code [shaded], e.g., IB is charged with IA.
Please note: If the patient is covered for plastic dyes, glass tints, or photochromics, there is no service fee for those lens enhancements. Additionally, for children or handicapped patients, there is no Service Fee for covered polycarbonate lenses when dispensed.

VSP Signature Plan
Charge patients the listed patient copay or your U&C fee, whichever is lower.
Effective July 1, 2018
Glass Tints and Color Coatings
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
MQ
(Lab Use Only)
--
--
--
--
--
--
MR
Glass Tints Solid (Except Pink I & II & Yellow)
$16
$14
$30
$24
$17
$41
MS
Glass Color Coatings – Solid
$22
$16
$38
$22
$16
$38
MT
Glass Color Coatings – Gradient
$25
$17
$42
$25
$17
$42
Photochromics
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
PM
Photochromics – Glass
$15
$14
$29
$23
$14
$37
PP
Photochromics – Plastic
$42
$20
$62
$51
$25
$76
^PP
Photochromics – Mid-index
$42
$20
$62
$51
$25
$76
Other Coatings
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
QM
Anti-reflective Coating A
$21
$16
$37
$21
$16
$37
QN
Anti-reflective Coating B
$34
$17
$51
$34
$17
$51
QT
Anti-reflective Coating C
$41
$20
$61
$41
$20
$61
QV
Anti-reflective Coating D
$52
$23
$75
$52
$23
$75
QP
Mirror – Solid & Single Gradient (Includes Base Color)
$26
$18
$44
$26
$18
$44
QR
Ski Type (Includes Base Tint and Backside Color)
$30
$20
$50
$30
$20
$50
QQ
Scratch-resistant Coating A – Factory Applied
$7
$8
$15
$7
$8
$15
QS
Scratch-resistant Coating B – Other Approved Coatings
$15
$14
$29
$15
$14
$29
Oversize
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
RM
Frames Stamped 61mm Eye Size or Greater – Plastic
$5
$5
$10
$6
$6
$12
RN
Frames Stamped 61mm Eye Size or Greater – Glass
$7
$5
$12
$10
$6
$16
Miscellaneous
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
SP
High-luster Edge Polish
$6
$8
$14
$6
$8
$14
SQ
Edge Coating
$17
$15
$32
$17
$15
$32
SR
Faceted Lenses (Includes Polishing)
$41
$20
$61
$41
$20
$61
SV
UV Protection
$6
$8
$14
$6
$8
$14
BV
UV Protection – Backside
$7
$3
$10
$7
$3
$10
TA
Technical Addon
$8
$2
$10
--
--
--
SH
(Lab Use Only)
--
--
--
--
--
--
ST
(Lab Use Only)
--
--
--
--
--
--
SW
(Lab Use Only)
--
--
--
--
--
--
Doctor Supplied
Single Vision
Multifocal
Code
Lens Enhancement Description
Charge Back
Service Fee
Patient Copay
Charge Back
Service Fee
Patient Copay
IM
Plastic Dyes – Solid Color (Pink I & II)
$5
--
--
$5
--
--
IN
Plastic Dyes – Solid Color (Except Pink I & II)
$5
$8
$13
$5
$8
$13
IP
Plastic Dyes – Gradient
$7
$8
$15
$7
$8
$15
IV
UV Protection
$6
$8
$14
$6
$8
ements.
lens enhancements.
$14
^If ordered with SunSensors or SunGray photochromics, lens enhancement code PP includes payment for mid-index materials. Please note: If the patient is covered for plastic dyes, glass tints, or photochromics, there is no service fee for those lens enhanc 1. In-office Lab: For the patient lens enhancements your office can fulfill in-house, you’ll be reimbursed this listed fee for covered For all other lens enhancements, this will be included in the patient copay you collect from the patient.

VSP Signature Plan
Charge patients the listed patient copay or your U&C fee, whichever is lower.
Effective July 1, 2018
Progressive
Code
Lens Enhancement Description
Charge Back
Service Fee2
Patient Copay
CM
Custom Measurements (on Eligible Progressive N or O) Lenses
$2
$8
$10
NA
Progressive N – Plastic
$95
$65
$160
NA + NB
Progressive N – High-index Plastic 1.53-1.60/Trivex
$25
$17
$160 + $42
NA + NH
Progressive N – High-index Plastic 1.66/1.67
$48
$24
$160 + $72
NA + NJ
Progressive N – High-index Plastic 1.70 & Above
$77
$38
$160 + $115
NA + ND
Progressive N – Polycarbonate
$15
$15
$160 + $30
NA + NP
Progressive N – Polarized
$51
$25
$160 + $76
OA
Progressive O – Plastic
$75
$45
$120
OA + OB
Progressive O – High-index Plastic 1.53-1.60/Trivex
$25
$17
$120 + $42
OA + OH
Progressive O – High-index Plastic 1.66/1.67
$48
$24
$120 + $72
OA + OJ
Progressive O – High-index Plastic 1.70 & Above
$77
$38
$120 + $115
OA + OD
Progressive O – Polycarbonate
$15
$15
$120 + $30
OA + OP
Progressive O – Polarized
$51
$25
$120 + $76
FA
Progressive F – Plastic
$54
$36
$90
FA + FB
Progressive F – High-index Plastic 1.53-1.60/Trivex
$25
$17
$90 + $42
FA + FH
Progressive F – High-index Plastic 1.66/1.67
$48
$24
$90 + $72
FA + FJ
Progressive F – High-index Plastic 1.70 & Above
$77
$38
$90 + $115
FA + FD
Progressive F – Polycarbonate
$15
$15
$90 + $30
FA + FP
Progressive F – Polarized
$51
$25
$90 + $76
FE
Progressive F – Glass/High-index Glass (Clear)
$59
$36
$95
JA
Progressive J – Plastic
$46
$34
$80
JA + JB
Progressive J – High-index Plastic 1.53-1.60/Trivex
$25
$17
$80 + $42
JA + JH
Progressive J – High-index Plastic 1.66/1.67
$48
$24
$80 + $72
JA + JJ
Progressive J – High-index Plastic 1.70 & Above
$77
$38
$80 + $115
JA + JD
Progressive J – Polycarbonate
$15
$15
$80 + $30
JA + JP
Progressive J – Polarized
$51
$25
$80 + $76
JE
Progressive J – Glass/High-index Glass (Clear)
$56
$34
$90
KA
Progressive K – Plastic
$30
$20
$50
KA + KB
Progressive K – High-index Plastic 1.53-1.60/Trivex
$25
$17
$50 + $42
KA + KH
Progressive K – High-index Plastic 1.66/1.67
$48
$24
$50 + $72
KA + KJ
Progressive K – High-index Plastic 1.70 & Above
$77
$38
$50 + $115
KA + KD
Progressive K – Polycarbonate
$15
$15
$50 + $30
KA + KP
Progressive K – Polarized
$51
$25
$50 + $76
KE
Progressive K – Glass/High-index Glass (Clear)
$50
$20
$70
+This lens enhancement code is always charged in conjunction with its base lens enhancement code [shaded], e.g., KD is charged with KA. 2. The Service Fee for progressives is paid in addition to your VSP Signature Plan bifocal dispensing fee.
Please note: For children or handicapped patients, there is no Service Fee for covered polycarbonate lenses when dispensed.
Progressive Categories3 as of 7/1/2018
Custom
N
Autograph III*, Hoyalux iD LifeStyle/2*, UNITY® Via Elite*, Varilux Physio Enhanced Fit/W3+ Fit*, Varilux X Fit Technology*, ZEISS DriveSafe Individual*, ZEISS Individual 2*
O
Autograph II+*, Kodak Unique, Shamir Intouch, synchrony Performance HDV, UNITY Via Plus/Mobile/Wrap*, Varilux Comfort W2+ Fit*, Varilux Physio Enhanced/W3+*, Varilux X Design Technology*, ZEISS Precision
Premium
F
KODAK Digital Precise, Shamir Spectrum+, synchrony Performance HD, UNITY Via, Varilux Comfort 2 DRx/Enhanced/W2+, Varilux Physio/DRx, ZEISS GT2, ZEISS Choice
J
Ethos Plus, Hoyalux GP Wide, Ideal Advanced, Kodak Precise/PB/Short, Shamir Element, synchrony Easy Adapt, Varilux Comfort 2, Varilux Ellipse
Standard
K
Accolade, Adaptar, Amplitude/Mini/BKS, Ethos, Image, Kodak Concise, Natural/Digital, Navigator, Ovation, SmallFit, synchrony Easy View/HD, VIP
3. If a lens is not shown, please refer to the Product Index in the Manuals on VSPOnline at eyefinity.com.
*This progressive lens is customizable for the most precise prescription. You’ll receive the additional CM service fee when the frame wrap, pantoscopic tilt, and vertex distance measurements are submitted with your lab order via eClaim at eyefinity.com. All three measurements are required. Refer to the Product Index in your VSPManual for additional eligible lenses.
©2018 Vision Service Plan. All rights reserved.
VSP and VSP Signature Plan are registered trademarks of Vision Service Plan. UNITY is a registered trademark, and Ethos is a trademark of Plexus Optix, Inc. All other brands are trademarks or registered trademarks of their respective owners. 31926 VCDR

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