23 Miss. Code. R. 217-3.2

Current through December 10, 2024

Rule 23-217-3.2 - Lens Coating

A. For purposes of this rule the following definitions will apply:

1. Antireflective is a coating applied to a lens to reduce the amount of reflected light and glare that reaches the eye.

2. Mirror coating is applied to a lens that allows the lens to take on the properties of a two-way mirror.

3. Scratch resistant coating is applied to a lens that helps retard crazing of the lens, thus extending the product life.

4. Tint is an opaque or transparent color coating applied to a lens. The parts of the light spectrum that are absorbed by the lens are determined by the color of the tint.

5. Photochromatic coating is applied to a lens that allows the lens to adjust to the amount of available light.

6. Polarized coating is applied to a lens that filters out reflected light and glare.

7. UV coating is applied to a lens to filter out ultraviolet light.

B. Medicaid covers tinted lenses, photochromatic lenses, or UV protected lens when medically necessary for the following medical diagnoses:

1. Other disturbances of aromatic amino-acid metabolism,

2. Degeneration of macula and posterior pole,

3. Pigmentary retinal dystrophy,

4. Cataracts,

5. Keratitis,

6. Corneal opacity and other disorders of cornea,

7. Disorders of conjunctiva,

8. Aphakia,

9. Congenital Aphakia,

10. Aniridia, and

11. Pseudophakos.

C. Non-covered services include:

1. Scratch resistant coating,

2. Antireflective coating,

3. Mirror coating,

4. Polarized coating, and

5. Diagnoses other than those listed under coverage criteria.

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

E. A beneficiary may purchase non-covered lens coating services. Charges for non-covered services must not be billed to Medicaid.

F. Documentation must comply with the requirements for maintenance of records set forth in Part 200, Chapter 1, Rule 1.3 in addition to following documentation specific to lenses and lens coating:

1. Orders and prescriptions for eyeglass lenses must include lens specifications such as lens type, power, axis, prism, absorptive factor, and impact resistance.

2. Orders and prescriptions for contact lenses must include lens specifications such as power, size, curvature, flexibility, and gas permeability.

3. Orders and prescriptions for lens coating must include appropriate diagnosis and/or narrative diagnosis.

23 Miss. Code. R. 217-3.2

Miss. Code Ann. § 43-13-121; 43-13-117; 43-13-118; 43-13-129