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OBE: FAQs - Optometry and Optical Services
- What specific Vision Care benefits are excluded from coverage for adult beneficiaries 21 years of age and older under the Medi-Cal program?
A: Effective for dates of service on or after July 1, 2009, all services relating to the supply, dispensing and repair of eyeglasses and other eye appliances (e.g., medically-necessary contact lenses and low vision devices) are no longer covered under the Medi-Cal program.
Please review the appropriate Medi-Cal provider manual for specific procedure code information.
- Are special ophthalmological services such as visual field testing provided by an optometrist covered by Medi-Cal for adult Medi-Cal beneficiaries?
A: Yes. All diagnostic, ancillary and supplemental procedures listed in the Rates: Maximum Reimbursement for Optometry Services section of the Vision Care manual are covered by Medi-Cal. All services relating to the supply, dispensing and repair of eyeglasses and other eye appliances remain a non-covered benefit for adult Medi-Cal beneficiares.
- When is the earliest date that optometry services can be provided to an adult Medi-Cal beneficiary?
A: Effective on or after July 26, 2010, providers may begin rendering optometric services to adult Medi-Cal beneficiaries.
- Are “low vision” examinations covered for adult Medi-Cal beneficiaries who are visually impaired?
A: Yes. The low-vision examination is a Medi-Cal covered benefit. However, if prescribed, low vision aids such as magnifiers and telescopes remain a non-covered benefit for adult Medi-Cal beneficiaries.
- Will the contact lens evaluation of patients with medically-necessary conditions such as keratoconus and aphakia be covered for adult Medi-Cal beneficiaries?
A: Yes. The contact lens evaluation is a Medi-Cal covered benefit that requires a Treatment Authorization Request for payment. If prescribed, the contact lenses themselves remain a non-covered benefit for adult Medi-Cal beneficiaries.
- Are “bandaged contact lenses” used for the treatment of medically-necessary conditions such as corneal abrasions covered for adult Medi-Cal beneficiaries?
A: Yes. Unlike other contact lens types prescribed for the purpose of improving vision, bandage contact lenses prescribed for the treatment of conditions such as corneal abrasions are a Medi-Cal covered benefit.