Current through September 24, 2024
A. For purposes of
this rule the following definitions will apply:
1. Antireflective is a coating applied to a
lens to reduce the amount of reflected light and glare that reaches the
eye.
2. Mirror coating is applied
to a lens that allows the lens to take on the properties of a two-way
mirror.
3. Scratch resistant
coating is applied to a lens that helps retard crazing of the lens, thus
extending the product life.
4. Tint
is an opaque or transparent color coating applied to a lens. The parts of the
light spectrum that are absorbed by the lens are determined by the color of the
tint.
5. Photochromatic coating is
applied to a lens that allows the lens to adjust to the amount of available
light.
6. Polarized coating is
applied to a lens that filters out reflected light and glare.
7. UV coating is applied to a lens to filter
out ultraviolet light.
B. Medicaid covers tinted lenses,
photochromatic lenses, or UV protected lens when medically necessary for the
following medical diagnoses:
1. Other
disturbances of aromatic amino-acid metabolism,
2. Degeneration of macula and posterior
pole,
3. Pigmentary retinal
dystrophy,
4. Cataracts,
5. Keratitis,
6. Corneal opacity and other disorders of
cornea,
7. Disorders of
conjunctiva,
8. Aphakia,
9. Congenital Aphakia,
10. Aniridia, and
11. Pseudophakos.
C. Non-covered services include:
1. Scratch resistant coating,
2. Antireflective coating,
3. Mirror coating,
4. Polarized coating, and
5. Diagnoses other than those listed under
coverage criteria.
D.
Prescriptions for lens coating must include the appropriate diagnosis code
and/or a narrative diagnosis.
E. A
beneficiary may purchase non-covered lens coating services. Charges for
non-covered services must not be billed to Medicaid.
F. Documentation must comply with the
requirements for maintenance of records set forth in Part 200, Chapter 1, Rule
1.3 in addition to following documentation specific to lenses and lens coating:
1. Orders and prescriptions for eyeglass
lenses must include lens specifications such as lens type, power, axis, prism,
absorptive factor, and impact resistance.
2. Orders and prescriptions for contact
lenses must include lens specifications such as power, size, curvature,
flexibility, and gas permeability.
3. Orders and prescriptions for lens coating
must include appropriate diagnosis and/or narrative diagnosis.
Miss. Code Ann. §
43-13-121;
43-13-117; 43-13-118; 43-13-129
