Important Notice from Texas Medicaid

Notice from Texas Medicaid

Vision Services Benefit to Change May 1, 2012 

Effective for dates of service on or after May 1, 2012, the benefit criteria for nonsurgical vision services will change for Texas Medicaid.

 

Eye Exams

Procedure codes S0621 and S0620 will be used for routine exams (wellness) with refractions and must be billed with diagnosis code V720.

Procedures codes S0621 and S0620 may be reimbursed to ophthalmologist, optometrist, optician, and dispensing optical company providers in the nursing home setting (place of service 8).

Procedure codes 92002, 92004, 92012, and 92014 will be used for medical evaluation and examinations and will not to be used for routine exams.  Procedure codes 92002, 92004, 92012, and 92014 will NO LONGER BE LIMITED TO ONCE PER YEAR OR ONCE EVERY 24 MONTHS. 

Procedure code 92002, 92004, 92012, or 92014 may be reimbursed to ophthalmologists and optometrists with one of the appropriate diagnosis codes.  Click here for announcement with a list of appropriate diagnosis codes. 

 

HMO, STAR, STAR-Plus Plans (Block Vision, OptiCare, etc.)

Effective for dates of service on or after May 1, 2012, exam procedure codes S0621 and S0620 will be used for routine exams with refractions and must be billed with diagnosis code V720. 

When completing the CMS1500 form, code V720 will be listed as the first diagnosis code and standard (367.0, 367.1, etc.) diagnosis codes second, third and so forth.  On the CMS1500 form Box 24 (E) you will match the S0620 or S0621 code with diagnosis pointer “1” which is the V720 code.  For glasses you will match the “V” codes with the appropriate diagnosis pointer (2, 3, etc.).  Always match the V720 code with the S0620 or S0621 exam codes.   

Please contact Ann Deen (cadeen@tso.com) or 214-704-1181 with any questions. You may also contact Medicaid directly (TMHP) at 1-800-925-9126.