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Elizabeth M. Whitehorn, Director

Provider Notice issued 06/30/12

Change to Adult Eyeglasses Benefit Effective July 1, 2012

To:​  Enrolled Optometrists, Optical Companies, and Physicians​
​Date: ​June 30, 2012
​Re: Change to Adult Eyeglasses Benefit Effective July 1, 2012​

As a result of Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, HFS is implementing the following change to the adult eyeglasses benefit.

Effective July 1, 2012, HFS will limit participants who are 21 years of age and older to one pair of eyeglasses in a two-year period. As of July 1, 2012, HFS will begin the two-year (730 days) count from the date of the last pair of eyeglasses ordered, based on CPT codes 92340 or 92341. As an example, if a patient last ordered eyewear with a date of service March 1, 2012, the department will count forward from that service date to determine eligibility for another pair of eyeglasses.

Claims for eyeglasses that do not meet the two-year time requirement will be rejected with error code F54 – Eyeglasses Not Fabricated Exceeds Limit. The department will deny any prior approval requests submitted for additional adult eyewear beyond the stated limit.

This policy change does not limit medically necessary eye examinations, or claims for repair/refitting of eyeglasses.

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs