5160-6-12 Spectacle fitting services.

(A) Spectacle fitting services are covered by medicaid. The consumer must be eligible at the time the fitting was initiated. If the exam and the fitting are performed by the same provider, the date of the exam may be considered the date the fitting was initiated. To be reimbursed for spectacle services, the provider must use the appropriate physicians' "Current Procedural Terminology (CPT)" code as referenced in rule5101:3-1-60 of the Administrative Code as listed in paragraphs (A)(1) to (A)(8) of this rule.

(1) 92340 - Monofocal, except for aphakia.

(2) 92341 - Bifocal, except for aphakia.

(3) 92342 - Multifocal, other than bifocal, except for aphakia.

(4) 92352 - Fitting of spectacle prosthesis for aphakia; monofocal.

(5) 92353 - Fitting of spectacle prosthesis for aphakia; multifocal.

(6) 92354 - Fitting of spectacle-mounted low-vision aid; monofocal.

(7) 92355 - Fitting of spectacle-mounted low-vision aid; telescopic or other compound lens system.

(8) 92358 - Prosthesis service for aphakia, temporary.

(B) Spectacle fitting services for less than a complete pair of spectacles, must be reported as a reduced service by using the modifier 52 following the procedure code. These services will be reimbursed at one-half the full service rate.

Effective: 01/01/2006
R.C. 119.032 review dates: 09/29/2005 and 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02
Prior Effective Dates: 7/22/86, 8/1/86, 8/22/88 (Emer), 11/18/88, 7/1/93, 7/1/02