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December 2016 Texas Medicaid Provider Procedures Manual

Vision and HearingServices Handbook : 4 Vision Care Professionals : 4.3 Services, Benefits, Limitations, and Prior Authorization : 4.3.7 Vision Services for Prosthetic Eyewear : 4.3.7.1 Eyeglasses or Contact Lenses Following Cataract Surgery

4.3.7.1
Temporary eyeglasses or contact lenses after cataract surgery may be reimbursed when they are billed with the appropriate lens and frame procedure codes and diagnosis code Z961.
Temporary eyeglasses or contact lenses may be reimbursed for up to 4 months after surgery until the client is ready for conventional eyeglasses or contact lenses, when it is medically necessary. The date of surgery is used to determine the convalescence period for temporary eyeglasses or contact lenses. Temporary eyeglasses or contact lenses will be denied if they are dispensed more than 4 months after the date of surgery.
Temporary eyeglasses or contact lenses may be reimbursed as often as is medically necessary during the postsurgical convalescence period.

Texas Medicaid & Healthcare Partnership
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