TMPPM 2008 > Texas Medicaid Services > Vision Care (Optometrists, Opticians) > Benefits and Limitations

45.4.6.2 Replacements

Regardless of age, coverage is provided for the replacement of lost or destroyed prosthetic eyewear. Providers must use procedure code 9-92326 when billing for contact lenses replacement. For replacement of cataract eyewear frames or lenses, providers must use the permanent cataract eyewear codes.

The client must sign and date the Vision Care Eyeglass Patient Certification Form, and the provider must retain it in the provider's records.

Medicare allows payment of one pair of conventional eyewear (contact lens or glasses) for clients who have had cataract surgery with insertion of an IOL. Medicare considers the IOL the prosthetic device. Medicaid providers must bill Medicare for the conventional (nonprosthetic) eyewear provided following an IOL insertion and bill Medicaid for any replacements of the conventional (nonprosthetic) eyewear using the Y codes from the "Nonprosthetic Eyeglasses and Contacts" tables beginning on page 45-10.