23 Miss. Code. R. 217-3.1

Current through December 10, 2024

Rule 23-217-3.1 - Coverage Criteria

A. Medicaid covers eyeglasses prescribed by an ophthalmologist or optometrist when documentation supports the following:

1. Eyeglasses are medically necessary,

2. Eyeglasses are prescribed to significantly improve vision or correct a medical condition, and

3. Eyeglasses meet eyeglass program specifications for frames and lenses.

B. Coverage benefits/limitations include:

1. Beneficiaries are allowed one (1) complete pair of eyeglasses every five (5) years. Prior authorization is not required unless manually priced codes are used. This includes eyeglass lenses and frames.

2. Repairs and replacements are not covered.

C. Prescriptions for eyeglass lenses must include lens specifications such as lens type, power, axis, prism, absorptive power, and impact resistance.

D. Prescriptions for lens coating must include the appropriate diagnosis codes and/or narrative diagnosis.

E. Lenses may be glass or plastic. All lenses must meet FDA impact resistant regulations.

F. Only standard frames with the appropriate code are covered. Deluxe frames are not covered. Eyeglass frames should be durable and constructed to be normally resistant to damage or breakage to minimize the need for replacement.

G. Fitting is a separate service and is covered. Fitting includes measurement of anatomical facial characteristics, the writing of laboratory specifications, and the final adjustment of spectacles to the visual axes and anatomical topography.

23 Miss. Code. R. 217-3.1

Miss. Code Ann. § 43-13-121; 43-13-117(1)