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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 : Prosthetic Replacement
Replacement prosthetic eyeglasses or contact lenses may be reimbursed as often as is medically necessary if the replacement is due to loss, destruction, or a significant change in visual acuity.
Replacement of eyeglasses or contact lenses is also allowed with a change in axis. A new prescription must have at least one of the following changes:
The appropriate eyeglass and frame or contact lens procedure codes must be billed with modifier RB to indicate replacement.
Refer to:
Subsection 4.3.6, “Nonprosthetic Eyeglasses or Contact Lenses” in this handbook for the eyeglass lens, frame, and contact lens procedure codes and dispensing requirements that apply to nonprosthetic eyewear.

Texas Medicaid & Healthcare Partnership
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