Recent court rulings now require the North Carolina Department of Health and Human Services to reverse provider rate reductions and restore rates to their Sept. 30, 2025, levels.
Topics Related to Optical Providers
Based on prior authorization and claim changes, optical providers (ophthalmologists, optometrists and opticians) should review NCTracks enrollment status to ensure there is an individual optical provider enrolled at the practice location where the visual aids are being ordered.
For more information, join the Virtual Office Hours webinar Thursday, June 5, 2025, at noon.
Guidance for ophthalmologists, optometrists and opticians regarding clinical coverage policies for medical and routine eye exams and visual aids.
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.