(a) The department will pay for only the
vision services and products identified in the Fee Schedule for Vision
Services, adopted by reference in
7
AAC 160.900, subject to the provisions of this
section.
(b) The department will
pay for the following services in each calendar year for a recipient under 21
years of age:
(1) one vision examination if
the vision examination meets the requirements of
7
AAC 110.710;
(2) any vision examination, in addition to
the examination in (1) of this subsection, if the department gives prior
authorization based upon medical justification submitted by the
provider;
(3) one complete pair of
eyeglasses, or a one-year supply of contact lenses, that meets the requirements
of (d) of this section;
(4) one
additional complete pair of eyeglasses, or additional supply of contact lenses
prorated for the remainder of the year, that meets the requirements of (d) of
this section, if the
(A) first pair of
eyeglasses or supply of contact lenses is lost or broken; or
(B) prescription changes;
(5) any subsequent complete pair
of eyeglasses, or subsequent supply of contact lenses prorated for the
remainder of the year, that meets the requirements of (d) of this section, if
the department gives prior authorization based upon medical justification
submitted by the provider;
(6) one
fitting for each pair of glasses covered under this subsection.
(c) The department will pay for
the following services for a recipient 21 years of age or older:
(1) in each calendar year period
(A) one vision examination, if the vision
examination meets the requirements of
7
AAC 110.710;
(B) any vision examination, in addition to
the examination in (A) of this paragraph, if the vision examination meets the
requirements of
7
AAC 110.710 and if the department gives prior
authorization based on medical justification submitted by the
provider;
(2) in each
two-year calendar year period
(A) one
complete pair of eyeglasses, or two one-year supplies of contact lenses that
meet the requirements of (d) of this section;
(B) one additional complete pair of glasses,
or additional supply of contact lenses prorated for the remainder of the
two-year period, that meets the requirements of (d) of this section, if the
department gives prior authorization based on medical justification submitted
by the provider;
(C) one fitting
for each pair of glasses covered under this
paragraph.
(d)
The department will pay for contact lenses and contact lens fittings that meet
the requirements of this section if
(1) the
claim is accompanied by written medical justification; and
(2) contacts are medically necessary as a
result of
(D) corneal degeneration;
(E) rejection of an implant; or
(F) ocular surface disease or abrasion
requiring temporary bandaging contact lens.
(e) In addition to authorization requirements
identified in this section, the following vision products and services require
prior authorization by the department, based upon medical justification
submitted by the provider:
