016-06-06 Ark. Code R. § 32
The following services are covered under the Arkansas Medicaid Program.
Procedure Code | Required Modifier | Description | Coverage | |
Under 21 | Over 21 | |||
DIAGNOSTIC AND ANCILLARY SERVICES | ||||
S0620 S0621 | - | VISION ANALYSIS AND DIAGNOSIS (SINGLE VISION) | yes | yes |
This service must include the following: case history, general health observation, external exam of the eye and adnexa, ophthalmoscopic examination, determination of refractive state, basic sensorimotor and binocularity examination. It may also include initiation of diagnostic and treatment programs or referral. | ||||
92340 | - | FITTING OF SPECTACLES, EXCEPT FOR APHAKIA: MONOFOCAL | yes | yes |
Fitting includes measurement of anatomical facial characteristics, the writing of laboratory specifications, and the final adjustment of the spectacles to the visual axes and anatomical topography. | ||||
99173 | UB | PRELIMINARY EVALUATION (MODIFIED SCREENING) | yes | yes |
This procedure must include at minimum three of the services listed under procedure code V0100. This code may not be billed in conjunction with procedure code V0100. | ||||
CONTACT LENS SERVICES | ||||
S0592 | - | VISION ANALYSIS AND CONTACT LENS EXAM | yes W/PA | yes W/PA |
This service must include the following: biomicroscopy, multiple ophthalmometry, case history, tear flow, measurement of ocular adnexa, initial tolerance evaluation, and may include other tests. This procedure does not include contact lens and should be billed in conjunction with other contact lens procedure codes. If billing this code, DO NOT bill S0620 or S0621. Contacts and glasses may be ordered using this code. | ||||
S0512 | - | SUPPLYING AND FITTING OF CONTACT LENS (SOFT) | yes W/PA | yes W/PA |
Spherical, aphakic, lenticular, toric, hydrophilic (per lens) | ||||
S0512 | SUPPLYING AND FITTING OF CONTACT LENS (GAS PERMEABLE) Spherical, aphakic, lenticular, toric, prism ballast (per lens) | yes W/PA | yes W/PA | |
V2501 | UA | SUPPLYING AND FITTING OF KERATOCONUS LENS (HARD OR GAS PERMEABLE) - per lens | yes W/PA | yes W/PA |
S0512 | " | SUPPLYING AND FITTING OF MONOCULAR LENS (HARD OR GAS PERMEABLE)-per lens | yes W/PA | yes W/PA |
V2501 | U1 | SUPPLYING AND FITTING OF MONOCULAR LENS (SOFT LENS) -per lens | yes W/PA | yes W/PA |
S0512 | SUPPLYING AND FITTING OF CONTACT LENS (SOFT) Spherical, aphakic, lenticular, toric, hydrophilic (per lens) | yes W/PA | yes W/PA | |
LOW VISION SERVICES | ||||
92002 | UB | LOWVISION EVALUATION | yes W/PA | yes W/PA |
SUPPLEMENTAL PROCEDURES | ||||
92081 | - | VISUAL FIELD - Electronic or Goldmann | yes | yes |
92081 | - | VISUAL FIELD - Confrontation Perimetry | yes | yes |
MISCELLANEOUS SERVICES | ||||
92100 | UB | TONOMETRY This procedure will only be covered when medically necessary. These conditions include, but are not limited to, diabetes, hypertension and age of the patient. | 92100 | UB |
V2623 | - | EYE PROSTHESIS Prosthetic eye, plastic, custom | yes W/PA | yes W/PA |
V2624 | " | POLISHING OF PROSTHESIS Polishing/resurfacing of ocular prosthesis | yes W/PA | yes W/PA |
REPAIRS AND MATERIAL SERVICES | ||||
V2025 | FRAME REPLACEMENT This procedure is for professional services only when replacing the whole frame. This procedure may be billed in conjunction with procedure code 92390 (Z0146) for material cost or the material may be ordered through the current optical contractor. | yes | no | |
PROFESSIONAL SERVICES FOR LENS REPLACEMENT | ||||
S0504 | RP | LENS REPLACEMENT - SINGLE VISION This procedure is for professional services only. It may be billed in conjunction with procedure code 92390 (Z0146) or through the current optical contractor. | yes | yes W/PA |
S0506 | RP | LENS REPLACEMENT - BIFOCAL This procedure is for professional services only. It may be billed in conjunction with procedure code 92390 (Z0146) or through the current optical contractor. | yes | yes W/PA |
CONTACT LENS REPLACEMENT | ||||
92326 | " | HARD LENS (PER LENS) This procedure code does not include a professional fee. | yes W/PA | no |
92326 | " | SOFT LENS (PER LENS) This procedure code does not include a professional fee. | yes W/PA | no |
92326 | " | GAS PERMEABLE (PER LENS) This procedure code does not include a professional fee. | yes W/PA | no |
92396 | - | APHAKIC LENS Post-operative cataract. | yes | yes W/PA |
92390 | SPECTACLE MATERIAL Cost of material for replacing frame, front, temple. This procedure code may be billed in conjunction with V2025 (Z0124), S0504 (Z0134) and S0506 (Z0136). This price may not exceed our maximum rates established with our current optical contractor. When this code is used, an invoice must be attached. | yes | no | |
V2799 | - | UNSPECIFIED PROCEDURE | yes | yes |
016.06.06 Ark. Code R. § 032