TMPPM 2008 > Texas Medicaid Services > Vision Care (Optometrists, Opticians) > Reimbursement

45.2 Reimbursement

Professional services by an optometrist for contact lenses and prosthetic eyewear are reimbursed in accordance with 1 TAC, §§355.8001, 355.8081, and 355.8085.

Fee schedules for services in this chapter are available on the TMHP website at www.tmhp.com/file library/file library/fee schedules. Federally qualified health centers (FQHCs) are paid an all-inclusive rate per visit for payable services. Specific procedure codes that meet the definition of a payable visit are marked with a "†."

Suppliers of nonprosthetic lenses and frames are reimbursed the lesser of their billed amount or of the established maximum allowable fee.

Optometrist services provided in a skilled nursing facility (SNF) or intermediate care facility for the mentally retarded (ICF-MR) may be reimbursed by the Texas Medicaid Program if the client's attending physician has ordered the service and the order is included in the client's medical records at the facility.

Refer to: "Reimbursement" for more information about reimbursement.

Vision Claim Form Example on page D-36

"Nonprosthetic Eyeglasses and Contacts"