Vision Nonsurgical Procedure Codes: Limitations Changed

Effective for dates of service on or after November 1, 2011, benefit limitations for some vision nonsurgical procedure codes have changed for Texas Medicaid. If applicable and consistent with 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 have changed to once per day, when billed by any provider.