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45.4.6.3 Significant Diopter Change
Clients are eligible for new prosthetic eyewear when there is a significant change in visual acuity (equal to or greater than 0.5 diopter in one eye). The new prescription must be indicated in Block 24D, line 5, and the old prescription directly below it in Block 24D, line 6 of the CMS-1500 claim form. Prescription information for electronic claims must be in the electronic claims format. Providers must consult their vendor for the location of this field in the providers' electronic format. The procedure codes listed for new eyewear must be used. Reimbursement is $61.37 per lens. Prior authorization is not required.
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