CSHCN 2009 > Vision Related Services > Benefits, Limitations, and Authorization Requirements

35.2.1.1 Authorization Requirements

Authorization is required for scleral lenses (procedure codes V2530 and V2531) and scleral lenses used as liquid bandage devices (procedure code S0515). Providers must submit the "CSHCN Services Program Authorization and Prior Authorization Request" form In Appendix B, page B-96; all fields of the form must be completed. Providers must indicate in the "Statement of Medical Necessity" section of the form that the client has a condition that is unresponsive to conservative treatment and requires a scleral lens or a liquid bandage, and that the client has a condition indicating a severe ocular surface disease including, but not limited to, the conditions listed below:

•Corneal ectasia such as keratoconus, pellucid marginal degeneration, keratoglobus (does not correct high order aberrations)

•Post keratoplasty astigmatism (generally provides excellent visual acuity and should be considered in lieu of wedge resections, relaxing incisions, and laser ablations)

•Terriens marginal degeneration

•Corneal surface irregularities due to ocular surface disease, anterior corneal dystrophies, scars, etc.

•Aphakia, high myopia/astigmatism

•Corneal stem cell deficiencies resulting from Stevens-Johnson syndrome and toxic epidermal necrosis (TEN), chemical and thermal injuries, ocular pemphigoid, aniridia, etc.

•Keratitis sicca due to disorders of the lacrimal gland such as Sjogren's syndrome, graft vs. host disease, irradiation, surgery, etc. and meibomian gland deficiency

•Neurotrophic corneas resulting from herpes simplex/zoster keratitis, congenital corneal anesthesia (dysautonomia), diabetes, acoustic neuroma surgery, trigeminal ganglionectomy, trigeminal rhyzotomy, etc.

•Persistent noninfectious corneal ulcers and epithelial defects associated with stem cell deficient and neurotrophic corneas

Refer to: Section 4.2, "Authorizations" for detailed information on authorization requirements.

Providers must submit the "CSHCN Services Program Authorization and Prior Authorization Request" form; all fields of the form must be completed. A copy of the "CSHCN Services Program Authorization and Prior Authorization Request" form is available in Appendix B, on page B-96.

Authorization is required for contact lenses for diagnosis codes other than the following:

Providers must submit the "CSHCN Services Program Authorization and Prior Authorization Request" form in Appendix B, on page B-96; all fields of the form must be completed. Providers must indicate in the "Statement of Medical Necessity" section of the form that no other option is available to correct a visual defect.

Refer to: Section 4.2, "Authorizations" for detailed information on authorization requirements.