Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-032 - Visual Care Transmittal Update #76

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.
Procedure Code
Required Modifier
Description
Coverage
Under 21
Over 21
DIAGNOSTIC AND ANCILLARY
						  SERVICES
S0620 S0621
-
VISION ANALYSIS AND DIAGNOSIS (SINGLE
						  VISION)
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.
99173
UB
PRELIMINARY EVALUATION (MODIFIED SCREENING)
yes
yes
This procedure must include at minimum three of the
						  services listed under procedure code V0100. This code may not be billed in
						  conjunction with procedure code V0100.
CONTACT LENS SERVICES
S0592
-
VISION ANALYSIS AND CONTACT LENS EXAM
yes W/PA
yes W/PA
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.
S0512
-
SUPPLYING AND FITTING OF CONTACT LENS
						  (SOFT)
yes W/PA
yes W/PA
Spherical, aphakic, lenticular, toric, hydrophilic (per
						  lens)
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
LOW VISION SERVICES
92002
UB
LOWVISION EVALUATION
yes W/PA
yes W/PA
SUPPLEMENTAL PROCEDURES
92081
-
VISUAL FIELD - Electronic or Goldmann
yes
yes
92081
-
VISUAL FIELD - Confrontation Perimetry
yes
yes
MISCELLANEOUS SERVICES
92100
UB
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.
92100
UB
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
REPAIRS AND MATERIAL SERVICES
V2025
FRAME REPLACEMENT This procedure is for professional
						  services only when replacing the whole frame. This procedure may be billed in
						  conjunction with procedure code 92390 (Z0146) for material cost or the material
						  may be ordered through the current optical contractor.
yes
no
PROFESSIONAL SERVICES FOR LENS
						  REPLACEMENT
S0504
RP
LENS REPLACEMENT - SINGLE
VISION
This procedure is for professional services only. It
						  may be billed in conjunction with procedure code 92390
(Z0146) or through the current optical
						  contractor.
yes
yes W/PA
S0506
RP
LENS REPLACEMENT - BIFOCAL This procedure is for
						  professional services only. It may be billed in conjunction with procedure code
						  92390 (Z0146) or through the current optical contractor.
yes
yes W/PA
CONTACT LENS REPLACEMENT
92326
"
HARD LENS (PER LENS)
This procedure code does not include a professional
						  fee.
yes W/PA
no
92326
"
SOFT LENS (PER LENS)
This procedure code does not include a professional
						  fee.
yes W/PA
no
92326
"
GAS PERMEABLE (PER LENS)
This procedure code does not include a professional
						  fee.
yes W/PA
no
92396
-
APHAKIC LENS Post-operative cataract.
yes
yes W/PA
92390
SPECTACLE MATERIAL Cost of material for replacing
						  frame, front, temple. This procedure code may be billed in conjunction with
						  V2025 (Z0124), S0504 (Z0134) and S0506 (Z0136). This price may not exceed our
						  maximum rates established with our current optical contractor. When this code
						  is used, an invoice must be attached.
yes
no
V2799
-
UNSPECIFIED PROCEDURE
yes
yes