Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-047 - Visual Care Provider Manual Update Transmittal #80

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)
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.
yes
yes
92340
-
FITTING OF SPECTACLES, EXCEPT FOR APHAKIA:
						  MONOFOCAL
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.
yes
yes
92370
-
FRAME REPAIR
Repair and refitting spectacles; except for
						  aphakia
yes
yes
99173
UB
PRELIMINARY EVALUATION (MODIFIED SCREENING)
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.
yes
yes
CONTACT LENS SERVICES
S0592
-
VISION ANALYSIS AND CONTACT LENS
						  EXAM
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
LOW VISION SERVICES
92002
UB
LOW VISION EVALUATION
yes W/PA
yes W/PA
SUPPLEM
ENTAL PRO
CEDURES
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
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
V2799
-
UNSPECIFIED PROCEDURE
yes
yes