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Correction to Vision Services – Nonsurgical Diagnosis Codes in 2025-2026 ICD-10 Special Bulletin

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The “Vision Services – Nonsurgical” section of the 2025-2026 International Classification of Diseases, Tenth Edition (ICD-10) Special Bulletin was incorrect.

The correct content is as follows:

Vision Services – Nonsurgical

Claims for ophthalmic ultrasound (procedure code 76514) may be reimbursed when they are submitted with the following diagnosis codes:

Added Diagnosis Codes
H40841H40842H40843Q8788    

Claims for gonioscopy (procedure code 92020) may be reimbursed when they are submitted with the following diagnosis codes:

Added Diagnosis Codes
H40841H40842H40843     

Claims for polycarbonate lenses (procedure code V2784) may be reimbursed when they are submitted with the following diagnosis codes:

Added Diagnosis Codes
G35AG35B0G35B1G35B2G35C0G35C1G35C2G35D
Q8787Q8788Q8981Q8989Q99811Q99812Q99813Q99818
Q99819QA00101QA00139QA00141QA00142QA00149QA00151 

Claims for polycarbonate lenses (procedure code V2784) that are submitted with the following diagnosis code will no longer be reimbursed for dates of service on or after October 1, 2025:

Discontinued Diagnosis Code
G35       

Providers may refer to the November Texas Medicaid Provider Procedures Manual, Vision and Hearing Services Handbook, section 4.3.6.2, “Ophthalmic Ultrasound,” section 4.3.6.3, “Gonioscopy,” and section 4.3.7.4, “Polycarbonate Lenses,” for additional information.

For more information, call the TMHP Contact Center at 800-925-9126.

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.