Author: GDIT, (800) 688-6696
The following co-payments are applicable for adult Medicaid beneficiaries (21 years of age and older):
- $3 - Routine eye exam (S0620 and S0621)
- $3 - Refraction only (92015)
- $2 - All visual aids (eyeglasses and medically necessary contact lenses)
In accordance with NCAC 22J. 0106, a provider may not withhold services from a beneficiary who is unable to pay a co-payment at the time the service is rendered. If a beneficiary is unable to pay, the provider may bill the beneficiary after the service is rendered for the unpaid co-payment.
For more information, please refer to Clinical Coverage Policies 6A: Routine Eye Examination and Visual Aids for Beneficiaries Under 21 Years of Age and 6B: Routine Eye Examination and Visual Aids for Beneficiaries 21 Years of Age and Older. Policies can be found at: https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies.