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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.46 Ophthalmology : Intraocular Lens (IOL)
An IOL (V2630, V2631, and V2632) may be reimbursed only to physicians in the office setting (POS 1). Providers must submit a copy of the manufacturer’s invoice for procedure code V2631 to TMHP with their claim. Reimbursement for the lens is limited to the actual acquisition cost for the lens (taking into account any discount) plus a handling fee not to exceed five percent of the acquisition cost.
Medicaid does not reimburse physicians who supply IOLs to ASCs/HASCs.
Reimbursement for the surgical procedure necessary to implant an IOL remains unchanged.

Texas Medicaid & Healthcare Partnership
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