Limitations to Change for Some Vision Nonsurgical Procedure Codes

Effective for dates of service on or after November 1, 2011, benefit limitations for some vision nonsurgical procedure codes will change for Texas Medicaid.

If applicable and consistent with the Centers for Medicare & Medicaid Services (CMS) billing guidelines, procedure codes must be billed with modifier LT or RT to identify the eye on which the service was performed. Texas Medicaid uses the CMS Physician Fee Schedule to identify procedure codes that are considered bilateral and for which reimbursement for the service is already based on the procedure being performed bilaterally. According to CMS guidelines, the following procedure codes are considered bilateral, and should not be billed with modifier LT, RT, or 50:

Procedure Codes

76514 76516 76519 92018 92019 92025 92132
92133 92134 92285

Effective for dates of service on or after November 1, 2011, limitations for these procedure codes will change to once per day, when billed by any provider.

For more information, call the TMHP Contact Center at 1-800-925-9126.

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