Optical Services

HOW TO ACCESS:

Optometrist, Opthamologist or Optical Supplier

ELIGIBILITY:

All Medicaid recipients.

COVERED SERVICES:

Recipients 0 to 21
Examinations and treatment of eye conditions, including examinations for vision correction, refraction error.

Regular eyeglasses when they meet a certain minimum strength requirement.  Medically necessary specialty eyewear and contact lenses with prior authorization.  Contact lenses are covered if they are the only means for restoring vision.

Other related services, if medically necessary.

Recipients 21 and over
Examinations and treatment of eye conditions, such as infections, cataracts, etc.

If the recipient has both Medicare and Medicaid, some vision related services may be covered.  The recipient should contact Medicare for more information since Medicare would be the primary payer.

COMMENTS:

Recipients 0 to 21
Specialty eyewear and contact lenses, if medically necessary for EPSDT eligibles requires Prior Authorization.  The provider will submit requests for the Prior Authorization.  A prior authorization approval does not guarantee patient eligibility.

Prescriptions are required for all glasses/contacts. After a prescription is obtained, the recipient may see an optical supplier to receive the glasses/contacts.

Recipients 21 and over
NON-COVERED SERVICES:

  • Routine eye examinations for vision correction
  • Routine eye examinations for refraction error
  • Eyeglasses


CONTACT:


Libby Gonzales

225/342-0490