Beginning in 2020, Unitedhealthcare Vision announced a new benefit for pregnant and nursing women. This benefit is offered free to our members and almost all members have this benefit. There are no plan design changes, this is simply an additional benefit for our members that allows for a second eye exam and replacement eyeglasses (eyeglasses only). The question is, how do you file it? The following explains what specifically should be entered on the claim for it to pay correctly. These details are also available in our Network Administration Manual –
1. The replacement exam and materials must be billed with the diagnosis codes Z33.1 or Z39.1 for claim processing.
2. Coverage of the glasses is dependent upon a cumulative change of 0.50 diopters or greater in sphere and/or cylinder power
3. There is a shift in cylinder axis that results in an increase in visual acuity
4. Follows the same copays, frame allowance, and price protections as the core plan
Below is an example of what will appear on the member’s benefit summary. Remember to ALWAYS check eligibility the day of the visit.If you have any other questions, please feel free to email me. Thanks for continuing to be great providers for our members!
Sr Provider Relations Advocate