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45.4.1.1 Refractive Errors
Procedure codes 1-S0620 and 1-S0621 are payable to optometrists when the diagnosis is refractive error.
Procedure code 1-S0620 or 1-S0621 is to be used by optometrists when billing for a Medicaid-only client and consists of preliminary diagnosis; analysis and complete diagnosis; and prescription and treatment.
Claims for eye examination services require a diagnosis. If eyeglasses are not prescribed, diagnosis code V720 may be used. V720 must not be used on claims for eyewear. If the diagnosis is not known by the supplier of the eyewear, diagnosis code 3689 is acceptable. Claims for eye examinations that lack a diagnosis are listed as an incomplete claim on the Remittance and Status (R&S) report and must be resubmitted for payment consideration. Electronic claims that lack a diagnosis will be rejected. A letter with the reason for rejection and instructions for resubmission will be mailed the following business day.
Procedure codes 1-S0620† and 1-S0621 are limited to the following diagnosis codes:
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