Reinstatement of Optometry Services - Frequently Asked Questions
QUESTION: When is the earliest date that optometry services can be provided to an adult Medi-Cal beneficiary?
ANSWER: Providers can begin rendering optometry services to adult Medi-Cal beneficiaries on July 26, 2010.
QUESTION: What services can optometrists now provide for adult beneficiaries (21 years of age and older) under the Medi-Cal Program?
ANSWER: In addition to general eye examinations and office visits, optometrists can provide most diagnostic, ancillary and supplemental procedures used for the evaluation of the visual system. For a list of optometry services now payable for adult beneficiaries under the Medi-Cal program, refer to the Rates: Maximum Reimbursement for Optometry Services section of the Medi-Cal Vision Care manual, which can be accessed at www.medi-cal.ca.gov.
QUESTION: Are eyeglasses and other eye appliances (e.g., medically necessary contact lenses, low vision aids, etc.) now covered for adult Medi-Cal beneficiaries also?
ANSWER: No, effective for dates of service on or after July 1, 2009, all services relating to the supply, dispensing and repair of eyeglasses and other eye appliances (e.g., medically-necessary contact lenses and low vision devices) are no longer covered under the Medi-Cal program.
QUESTION: Are "low vision" examinations covered for adult Medi-Cal beneficiaries who are visually impaired?
ANSWER: Yes, the low vision examination is a Medi-Cal covered benefit. However, if prescribed, low vision aids such as magnifiers and telescopes remain a non-covered benefit for adult Medi-Cal beneficiaries.
QUESTION:Is the contact lens evaluation for medically necessary conditions such as keratoconus covered for adult Medi-Cal beneficiaries?
ANSWER: Yes, however, contact lenses prescribed for the treatment of keratoconus and other medically necessary conditions remain non-covered benefits for adult Medi-Cal beneficiaries. For payment, the contact lens evaluation requires a Treatment Authorization Request.
QUESTION: Are bandaged contact lenses used for the treatment of medically necessary conditions such as corneal abrasions covered for adult Medi-Cal beneficiaries?
ANSWER: Yes, unlike other contact lens types prescribed for the purpose of improving vision, bandage contact lenses prescribed for the treatment of conditions such as corneal abrasions are a Medi-Cal covered benefit.
QUESTION: With the elimination of Optional Benefits, who are still covered for eyeglasses and other eye appliances?
ANSWER: Effective July 1, 2009, only children or young adults under 21 years of age and residents of a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) including ICF-DD Habilitative and ICF-DD Nursing are eligible for eyeglasses and other eye appliances.