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Optician Services Restored as Medi-Cal Benefits

December 10, 2019

Effective for dates of service on or after January 1, 2020, optional benefit optician services, including services provided by a fabricating optical laboratory (FOL), previously eliminated as part of the optional benefits exclusion are reinstated as Medi-Cal benefits for eligible full-scope Medi-Cal recipients 21 years of age or older.

Effective for dates of service on or after January 1, 2020, optical providers in all counties, including San Luis Obispo, San Mateo and Santa Barbara, are limited to billing the following CPT codes 92340, 92341, 92342, 92352 or 92353 for dispensing of ophthalmic lenses fabricated by Prison Industry Authority (PIA) optical laboratories for eligible Medi-Cal recipients.

Effective for dates of service on or after January 1, 2020, the Medi-Cal contracted FOL bills for lens fabrication for all counties, including San Luis Obispo, San Mateo and Santa Barbara, using the appropriate HCPCS codes.

All optical providers will use PIA optical laboratories to fabricate lenses.

Updated manual pages will be released in a future Medi-Cal Update.