Standard eyewear is ___________ ________ __________
What is covered in full
100
Medically necessary eye care services may be covered if performed by an
What is optometrist
100
Timely filing period
What is 95 days
100
All medical/surgical procedures performed by an ____________ are not covered.
What is ophthalmologist
200
Ages that may receive a routine vision exam once per 24 month period
What is 21 and over
200
If members choose to opt-out of the standard eyewear benefit, they have
What is $100
200
Contact lenses may be optained in lieu of eyeglasses when
What is there is no other way to correct a visual defect.
200
The code for refraction that must be filed seperately from the routine vision exam
What is 92015
200
______ which are ground into the lenses are not covered
What is prisms
300
The eye exam limitation can be exceeded for members under 21 due to medical necessity or a request from the _______ _______, __________, or ___________.
What is school nurse, teacher, parent
300
The allowance may not be used towards ______, _________, _________, ____________.
What is disposable contacts, add-ons, replacement eyewear, or sunglasses
300
Add-on that is covered in full when dispensed in accordance with Texas Medicaid guidelines.
What is polycarbonate lenses
300
Modifiers that may be used when filing for replacements
What are RA or RB
300
The fitting, measurement and K-reading for _______ ______ are not covered unless medically indicated.
What is contact lenses
400
Frequency for routine vision exams is based on
What is date of service
400
Eligible members may receive _____ ________ per _______ ________ period.
What is one pair, 24 month
400
Frequency that members who have undergone cataract surgery are eligible for one pair of standard frames and lenses, or conventional contact lenses
What is once per eye, per lifetime
400
This code should be used when biling usual and customary repairs over $2
What is V2799
400
Non-prescription eyewear and __________ are not covered.
What is sunglasses
500
Routine exams may be performed by OD ______ MD.
What is and/or
500
Members may receive new materials if there has been a change of
What is 0.5 diopter in either eye
500
High-powered lenses are ________ ____ _________ _________ and no pre-authorization is required.
What is covered when medically necessary
500
True or False: Members are allowed to go to an Out-of-Network provider and submit an itemized bill for reimbursement
What is false
500
The member does not have to pay for eyewear if they