Mont. Admin. R. 37.86.2002 - OPTOMETRIC SERVICES, REQUIREMENTS
(1)
These requirements are in addition to the rule provisions generally applicable
to Medicaid providers.
(2) The
department hereby adopts and incorporates by reference the definitions found in
the introduction of Physicians Current Procedural Terminology, fourth edition
(CPT 4), published by the American Medical Association of Chicago, Illinois.
These materials set forth meanings of terms commonly used by the Montana
Medicaid program in implementation of the program's optometric schedule. A copy
of the definitions herein incorporated may be obtained through the Department
of Public Health and Human Services, Health Resources Division, P.O. Box
202951, 1400 Broadway, Helena, MT 59620-2951. Providers must bill for services
using the procedure codes, and modifiers set forth, and according to the
definitions contained in the Health Care Financing Administration's Common
Procedure Coding System (HCPCS). Information regarding billing codes, modifiers
and HCPCS is available upon request from the Health Resources Division at the
address stated above.
(3) A
Medicaid member under 21 years of age is limited to one eye examination for
determination of refractive state per 365-day period. A Medicaid member 21
years of age or older is limited to one eye examination for determination of
refractive state per 730-day period unless one of the following circumstances
exist:
(a) following cataract surgery more
than one examination during the 365-day period is necessary; or
(b) the provider determines by screening that
a loss of one line acuity has occurred with present glasses.
Notes
AUTH: 53-6-113, MCA; IMP: 53-6-101, 53-6-141, MCA
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