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2012 Texas Medicaid Provider Procedures Manual

Vision and Hearing Services Handbook : 4. Vision Care Professionals : 4.3 Services, Benefits, Limitations, and Prior Authorization

4.3 Services, Benefits, Limitations, and Prior Authorization
Examination and treatment of eye conditions, including prescribing and dispensing of medically necessary eyeglasses or contact lenses, are benefits of Texas Medicaid and may be reimbursed to optometrist, ophthalmologist, and optician providers as is within the scope of practice for each.
The following services are included in other services and will not be considered for separate reimbursement:
Expenses for medical supplies, equipment, and other items that are not specifically made-to-order for the client are considered to have been incurred on the date the item is delivered.
Ophthalmologist and Optometrist
Examination and treatment services rendered by an ophthalmologist or optometrist are not limited to the procedure codes included in this handbook.
Refer to:
The Texas Medicaid fee schedules on the TMHP web site at for a complete list of procedure codes that may be reimbursed by Texas Medicaid.
Services rendered by an optician are limited to fitting and dispensing of medically necessary eyeglasses and contact lenses.
In accordance with the Omnibus Reconciliation Act of 1986, Section 9336, a Doctor of Optometry is considered a physician, with respect to the provision of any item or service the optometrist is authorized to perform by state law or regulation.

Texas Medicaid & Healthcare Partnership
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