Guidance for ophthalmologists, optometrists and opticians regarding clinical coverage policies for medical and routine eye exams and visual aids.
Topics Related to Optical Providers
In the Feb. 1, 2022, bulletin, incorrect Maximum Allowable Rates were entered in the NC Medicaid Eyeglasses Dispensing Fee Schedule table.
Provides information for providers of beneficiaries enrolled in NC Medicaid Direct and NC Medicaid Managed Care
Eyeglasses dispensing fee schedule, coverage of eyeglasses components, and provider billing and Medicaid payment.
Medicaid requires claims for CPT code 68761 be billed with one of four modifiers.
This replaces the bulletin, published on Aug. 4, 2021
When an NC Medicaid Managed Care member becomes part of a population exempted or excluded, they are disenrolled and transition to NC Medicaid Direct.
Providers must submit ALL eyeglasses prior approval requests for NC Medicaid Direct beneficiaries and health plan members to NCTracks.
Providers must submit a contact lens prior approval request to NCTracks for a beneficiary who has transferred back to NC Medicaid Direct.
Eligible Providers and Services - Optometrists may now bill for the following services when delivered remotely: