Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.11-025 - Provider Manual Update Transmittal VISUAL-1-11

Current through Register Vol. 49, No. 6, June, 2024
Section II Visual Care
242.110
Visual Procedure Codes
The following services are covered under the Arkansas Medicaid
				Program. "W/PA" means that a service requires prior authorization.
Procedure Code
Required Modifier
Description
Coverage
Under 21
Over 21
DIAGNOSTIC AND ANCILLARY
						  SERVICES
S0620
-
ROUTINE OPTHALMOLOGICAL EXAMINATION INCLUDING
						  REFRACTION; NEW PATIENT
yes
yes
This service must include the following: case history,
						  general health observation, external exam of the eye and adnexa,
						  ophthalmoscopic examination, determination of refractive state, basic
						  sensorimotor and binocularity examination. It may also include initiation of
						  diagnostic and treatment programs or referral.
S0621
-
ROUTINE OPTHALMOLOGICAL EXAMINATION INCLUDING
						  REFRACTION: ESTABLISHED PATIENT
yes
yes
This service must include the following: case history,
						  general health observation, external exam of the eye and adnexa,
						  ophthalmoscopic examination, determination of refractive state, basic
						  sensorimotor and binocularity examination. It may also include initiation of
						  diagnostic and treatment programs or referral.
92340
-
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA:
						  MONOFOCAL
yes
yes
Fitting includes measurement of anatomical facial
						  characteristics, the writing of laboratory specifications, and the final
						  adjustment of the spectacles to the visual axes and anatomical
						  topography.
92370
-
REPAIR AND REFITTING OF SPECTACLES
yes
yes
W/PA
Repair and refitting spectacles; except for
						  aphakia
99173
UB
SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE,
						  BILATERAL This procedure must include at a minimum three components listed
						  under procedure code S0620 or S0621. This code may not be billed in conjunction
						  with procedure code S0620 or S0621.
yes
yes
CONTACT LENS SERVICES
S0592
COMPREHENSIVE CONTACT LENS EVALUATION
This service must include the following: biomicroscopy,
						  multiple ophthalmometry, case history, tear flow, measurement of ocular adnexa,
						  initial tolerance evaluation, and may include other tests. This procedure does
						  not include contact lens and should be billed in conjunction with other contact
						  lens procedure codes. If billing this code, DO
NOT
bill S0620 or
						  S0621. Contacts and glasses may be ordered using this code.
yes W/PA
yes W/PA
S0512
SUPPLYING AND FITTING OF CONTACT LENS (SOFT) Spherical,
						  aphakic, lenticular, toric, hydrophilic (per lens)
yes W/PA
yes W/PA
S0512
SUPPLYING AND FITTING OF CONTACT LENS (GAS PERMEABLE)
						  Spherical, aphakic, lenticular, toric, prism ballast (per lens)
yes W/PA
yes W/PA
V2501
UA
SUPPLYING AND FITTING OF KERATOCONUS LENS (HARD OR GAS
						  PERMEABLE) - per lens
yes W/PA
yes W/PA
S0512
"
SUPPLYING AND FITTING OF MONOCULAR LENS (HARD OR GAS
						  PERMEABLE)-per lens
yes W/PA
yes W/PA
V2501
U1
SUPPLYING AND FITTING OF MONOCULAR LENS (SOFT LENS)
						  -per lens
yes W/PA
yes W/PA
S0512
SUPPLYING AND FITTING OF CONTACT LENS (SOFT) Spherical,
						  aphakic, lenticular, toric, hydrophilic (per lens)
yes W/PA
yes W/PA
S0500
-
DISPOSABLE CONTACTS (PER LENS)
yes W/PA
yes W/PA
LOWVISK
DN SERVICES
92002
OPHTHALMOLOGICAL SERIVICES: Medical examination and
						  evaluation with initiation of diagnostic and treatment program; intermediate,
						  new patient
yes
yes
SUPPLEMENTAL PROCEDURES
92081
VISUAL FIELD EXAMINATION Unilateral or bilateral, with
						  interpretation and report; limited examination
yes
yes
92082
VISUAL FIELD EXAMINATION Unilateral or bilateral, with
						  interpretation and report; intermediate examination
yes
yes
92083
VISUAL FIELD EXAMINATION Unilateral or bilateral, with
						  interpretation and report; extended examination
yes
yes
MISCELLANEOUS SERVICES
92100
TONOMETRY
This procedure will only be covered when medically
						  necessary. These conditions include, but are not limited to,
diabetes, hypertension and age of the
						  patient.
yes
yes
92065
---
ORTHOPTIC AND PLEOPTIC TRAINING WITH CONTINUING MEDICAL
						  DIRECTION AND EVALUATION
yes W/PA
no
92060
SENSORIMOTOR EXAMINATION
With multiple measurements of ocular deviation (e.g.,
						  restrictive or paretic muscle with diplopia) with interpretation and report
						  (separate procedure).
yes W/PA
no
96111
DEVELOPMENTAL TESTING
Extended (includes assessment of motor, language,
						  social, adaptive and/or cognitive functioning by standardized developmental
						  instruments) with interpretation and report.
yes W/PA
no
CONTACT LENS REPLACEMENT
92326
HARD LENS (PER LENS)
This procedure code does not include a professional
						  fee.
yes W/PA
yes W/PA
92326
SOFT LENS (PER LENS)
This procedure code does not include a professional
						  fee.
yes W/PA
yes W/PA
92326
---
GAS PERMEABLE (PER LENS)
This procedure code does not include a professional
						  fee.
yes W/PA
yes W/PA
92326
-
APHAKIC LENS Post-operative cataract.
yes W/PA
yes W/PA
V2799
-
UNSPECIFIED PROCEDURE
yes
yes
EYE PROSTHESIS
V2623
-
EYE PROSTHESIS Prosthetic eye, plastic,
						  custom
yes W/PA
yes W/PA
V2624
-
POLISHING OF PROSTHESIS Polishing/resurfacing of ocular
						  prosthesis
yes W/PA
yes W/PA
V2625
-
ENLARGEMENT of ocular prosthesis
yes W/PA
yes W/PA
V2626
-
REDUCTION of ocular prosthesis
yes W/PA
yes W/PA