Eye Examination and Refraction Testing
Certified nurse midwifes, registered nurses, or licensed midwifes can no longer
provide services rendered in the office, inpatient hospital, or outpatient hospital
setting for procedure code 92014.
Ophthalmic Ultrasound
The following diagnosis codes will be added to procedure code 76514:
The following diagnosis codes will no longer be allowed for procedure code 76514:
For procedure code 76514, the current one per lifetime limitation does not apply
when used with diagnosis codes H1811, H1812, H1813, H18211, H18212, H18213,
H18231, H18232, H18233, H1851, H21551, H21552, H21553, T86840, T86841, or
Z947.
Procedure codes 76519 and 92136 with the appropriate LT or RT modifier may be
allowed for one service per eye, per day and two services per lifetime.
Ophthalmic biometry procedure codes 76519 and 92136 are duplicative tests and
cannot be performed together.
Ophthalmic biometry may be repeated after 12 months if the patient decides to
have the surgery later or the procedure is performed by a different provider.
Requests for a second ophthalmic biometry in less than 12 months will not be
allowed without documentation of significant change in vision.
Gonioscopy
The following diagnosis codes will be added for procedure code 92020:
Added Diagnosis Codes
The following diagnosis codes will no longer be allowed for procedure code 92020:
Corneal Topography
Physician assistants, nurse practitioners, clinical nurse specialists, physicians,
optometrists, federally qualified health centers (FQHC), and optometric groups in
the inpatient and outpatient hospital setting may perform the professional
component of procedure code 92025.
Orthoptic or Pleoptic Training
Limitation for procedure code 92065 will be expanded from 2 to 12 services per
lifetime. Providers must document in the medical record a diagnosis and the reason
for continuous treatment if the client attends multiple training sessions.
Physician assistants, nurse practitioners, clinical nurse specialists, physicians,
optometrists, federally qualified health centers (FQHC), and optometric groups in
the inpatient and outpatient hospital setting may perform procedure code 92065.
Contact Fitting for Corneal Bandage Lens
When performing services using procedure codes 92071 or 90272, the following V-Codes must be used:
Procedure code 92071 will be limited to one service, per eye, per day. The LT or RT
modifier must be used to identify the eye on which the service was performed.
Scanning Computerized Ophthalmic Diagnostic Imaging
For procedure code 92134, after two services have been rendered, additional
services might be allowed for a total of 12 services per calendar year.
Ophthalmoscopy, Extended Ophthalmoscopy and Fluorescein Angiography
Procedure codes 92201 and 92202 are limited to one service per day. The year
limitation will be expanded to 12 services per calendar year. Updated criteria for
medical necessity will be included in the Texas Medicaid Provider Procedures
Manual, Vision and Hearing Services Handbook. Providers must keep supporting
documentation in the client’s medical record when additional services are
performed.
FQHC providers may use procedure codes 92227 and 92228 for services rendered
in the office and outpatient hospital setting.
FQHC providers may no longer use procedure codes 92230, 92235, 92240, 92242,
92250, and 92260 for services rendered in the inpatient hospital setting.
Procedure codes 92235 and 92240 will no longer have LT/RT modifier requirements
and will be limited to one procedure per day and two services per calendar year.
Procedure code 92260 will no longer be diagnosis restricted.
Other Specialized Vision Services
The technical component for procedure code 92285 is now a benefit for portable xray supplier, radiological or physiological lab providers in the office setting.
Polycarbonate Lenses
The following diagnosis codes will be added for procedure code V2784:
Eyeglasses or Contact Lenses
Procedure code V2221 will no longer be a benefit to any provider type in the home
setting.
Procedure codes V2410 and V2430 will be limited to one pair of non-prosthetic
lenses per 24 calendar months.
Procedure code V2799 will no longer be a benefit to any provider type in the home,
independent laboratory, or birthing center setting.