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45.4.4.3 Repairs
Clients younger than 21 years of age may obtain repairs of nonprosthetic eyewear when the actual cost of materials exceeds $2. An invoice for the repair materials is not required to be submitted with the claim. Providers are required to maintain this information in the client's medical file and make it available for review by TMHP, HHSC, or the Attorney General's office when requested. The cost of repair supplies cannot exceed the amount that would have been payable, if the damaged eyewear had been a new purchase. All repair materials billed to the Texas Medicaid Program must be new and at least equivalent to the original item.
Repairs costing $2 or less are considered minor repairs. The eyeglass supplier is required to perform minor repairs on request (without charge) on eyewear that they have dispensed. Therefore, the Texas Medicaid Program or the client may not be billed for any minor repairs.
No benefits are allowed for repair of eyeglasses that do not meet the minimum program specifications or for clients who are eligible for Medicaid and are 21 years of age and older.
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