| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
Yes
|
$1/visit
|
Orthoptics and orthoptic training
|
1 refractive exam/2 years
|
Fee for service
|
CN
|
|
Alaska
|
|
Yes
|
|
|
1 refractive exam/year
|
Fee for service
|
CN
|
|
Arizona
|
|
Yes
|
|
|
Limited to emergency eye care and treatment of medical conditions, vision exam limited to post-cataract surgery services
|
Fee for service
|
CN & MN
|
|
Arkansas
|
|
Yes
|
|
|
1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners
|
Fee for service
|
CN & MN
|
|
California
|
|
Yes
|
$1/visit
|
|
1 refractive exam/2 years, orthoptics not covered
|
Fee for service
|
CN & MN
|
|
Colorado
|
|
Yes
|
$2/visit
|
Yes
|
|
Fee for service
|
CN
|
|
Connecticut
|
|
Yes
|
|
Visual training
|
1 refractive exam/year
|
Fee for service with some services paid 90% of physician fee
|
CN & MN
|
|
Delaware
|
|
Yes
|
|
|
Limited to diagnosis and treatment of medical eye problems as permitted by law
|
Fee for service
|
CN
|
|
District of Columbia
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Florida
|
|
Yes
|
$2/day
|
|
Eye exams limited to determining presence of disease or reported vision problem
|
Fee for service
|
CN & MN
|
|
Georgia
|
|
Yes
|
$.50-$3 for selected services dependng on payment rate
|
|
Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care, refractive exams covered for nursing facility residents with specific physician order
|
Fee for service at 84.645% of CMS RBRVS rates for 2000
|
CN & MN
|
|
Hawaii
|
|
Yes
|
|
|
1 refractive exam/2 years
|
Fee for service
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
1 refractive exam/year
|
Fee for service
|
CN
|
|
Illinois
|
|
Yes
|
$2/visit
|
Specified items, including visual aids
|
1 refractive exam/year
|
Fee for service or certified cost
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
|
1 refractive exam/2 years
|
Fee for service
|
CN
|
|
Iowa
|
|
Yes
|
$2/day
|
|
1 refractive exam/year, visual aids covered when visual acuity criteria met and visual therapy limited to 90 days
|
Fee for service
|
CN & MN
|
|
Kansas
|
|
Yes
|
$2/date of service
|
|
1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered
|
Fee for service
|
CN & MN
|
|
Kentucky
|
|
Yes
|
A, C & D - $2/visit
|
|
Limited to diagnosis and treatment of medical eye problems as permitted by law
|
Fee for service
|
A, B, C & D - See state-specific FN
|
|
Louisiana
|
|
Yes
|
|
|
Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit
|
Fee for service
|
CN & MN
|
|
Maine
|
|
Yes
|
$.50-$2/day, depending on payment, up to $20/month
|
Specified services
|
Limited to dispensing and fitting eyeglasses and 1 routine eye exam/2 years, 1 routine eye exam/year for ICF/MR residents
|
Fee for service
|
CN & MN
|
|
Maryland
|
|
Yes
|
|
|
1 refractive exam/2 years
|
Fee for service
|
CN & MN
|
|
Massachusetts
|
|
Yes
|
|
Specified services/items including vision training
|
1 refractive exam/2 years unless specific diagnostic criteria met
|
Fee for service
|
CN & MN
|
|
Michigan
|
|
Yes
|
$2/visit
|
|
1 refractive exam/2 years
|
Fee for service
|
CN & MN
|
|
Minnesota
|
|
Yes
|
$3/visit for non-preventive service
|
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Mississippi
|
|
Yes
|
$3/visit
|
Specified services
|
1 refractive exam/5 years included in physician visit limitations
|
Fee for service
|
CN
|
|
Missouri
|
|
Yes
|
$.50-$3/service, depending on payment
|
|
1 vision exam/year with or without refraction except adults who are not pregnant, blind or residing in nursing facilities are limited to 1 exam/2 years
|
Fee for service
|
CN & MN
|
|
Montana
|
|
Yes
|
$2/visit
|
Visual training
|
A - 1 refractive exam/2 years, additional exams allowed for cataract care
B - Limited to exams essential for employment
|
Fee for service
|
A & B - See state-specific FN
|
|
Nebraska
|
|
Yes
|
$2/visit
|
|
1 refractive exam/2 years
|
Fee for service
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
|
Limited to treatment of medical conditions, including glaucoma and cataracts
|
Fee for service
|
CN
|
|
New Hampshire
|
|
Yes
|
|
|
1 refractive exam/year
|
Fee for service
|
CN & MN
|
|
New Jersey
|
|
Yes
|
|
Visual testing and training
|
Visual aids covered when visual acuity criteria met
|
Fee for service
|
CN & MN
|
|
New Mexico
|
|
Yes
|
A - $5/visit, B - $7/visit - see state-specific FN
|
|
1 refractive exam/2 years
|
Fee for service
|
CN
|
|
New York
|
|
Yes
|
|
|
1 refractive exam/2 years, visual aids covered when visual acuity criteria met
|
Fee for service
|
CN & MN
|
|
North Carolina
|
|
Yes
|
$3/visit
|
Visual aids
|
8 visits/year included in limits with other specified practitioners - limits set annually by the legislature
|
Fee for service
|
CN & MN
|
|
North Dakota
|
|
Yes
|
$2/visit
|
|
1 refractive exam/3 years
|
Fee for service
|
CN & MN
|
|
Ohio
|
|
Yes
|
$2/refractive exam visit, $1/dispensing date of service
|
|
1 refractive exam/2 years for over age 20 and under 60, 1 exam/year for age 60 and older
|
Fee for service
|
CN
|
|
Oklahoma
|
|
Yes
|
$1/service
|
|
4 ambulatory visits/month included in physician limit, services limited to medical care only
|
Fee for service
|
CN
|
|
Oregon
|
|
Yes
|
A - $3/visit
|
|
1 refractive exam/2 years
|
Fee for service
|
A - See state-specific FN
|
|
Pennsylvania
|
|
Yes
|
$.50-$3/service, depending on payment rate
|
|
2 vision exams/year,
|
Fee for service
|
CN & MN
|
|
Rhode Island
|
|
Yes
|
|
|
1 refractive exam/2 years
|
Fee for service
|
CN & MN - see state-specific FN
|
|
South Carolina
|
|
Yes
|
$2/visit - applicable to specified E&M services only
null
|
|
1 refractive exam/year
|
Fee for service
|
CN
|
|
South Dakota
|
|
Yes
|
$3/visit
|
|
Refractive exams only
|
Fee for service
|
CN
|
|
Tennessee
|
|
Yes
|
|
|
Limited to medical eye care, refractive exams not covered
|
|
A & B - See state-specific FN
|
|
Texas
|
|
Yes
|
|
|
1 refractive exam/2 years
|
Fee for service
|
CN & MN
|
|
Utah
|
|
Yes
|
B - balance of exam cost over $30, C - $5/visit
|
|
A - adult coverage limited to pregnant women, B & C - 1 refractive exam/year, low vision therapy not covered
|
Fee for service
|
A, B & C - See state-specific FN
|
|
Vermont
|
|
Yes
|
|
|
A - 1 comprehensive exam/2 years, B - 1 comprehensive exam/2 years and only covered under PC Plus
|
Fee for service
|
A & B - See state-specific FN
|
|
Virginia
|
|
Yes
|
$1/visit
|
|
Refractive exams only
|
Fee for service
|
CN & MN
|
|
Washington
|
|
Yes
|
|
|
1 refractive exam/2 years, orthoptic therapy not covered
|
Fee for service
|
CN & MN
|
|
West Virginia
|
|
Yes
|
|
|
1 refractive exam/3 years
|
Fee for service
|
A & B
|
|
Wisconsin
|
|
Yes
|
$.50-$3, depending on service
|
Specified services
|
|
Fee for service
|
CN & MN
|
|
Wyoming
|
|
Yes
|
$2/visit
|
|
Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care
|
Fee for service
|
CN
|
|
American Samoa
|
|
Yes
|
|
|
|
|
See territory-specific FN
|
|
Guam
|
|
Yes
|
|
Yes
|
|
Fee for service
|
CN
|
|
Northern Mariana Islands
|
|
Yes
|
|
|
|
|
CN & MN - See territory-specific FN
|
|
Puerto Rico
|
|
Yes
|
|
|
Limited to exams and evaluations
|
Fee for service for contracted staff, cost based payment for public health staff
|
CN & MN
|
|
Virgin Islands
|
|
Yes
|
|
|
Limited to dispensing and fitting eyeglasses
|
Fee for service
|
CN
|
