AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidRULE NO: RULE TITLE
59G-4.210: Optometric ServicesNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 32, No. 49, December 8, 2006 issue of the Florida Administrative Weekly.
These changes are in response to written comments received prior to the public hearing. The rule incorporates by reference Update January 2007 to the Florida Medicaid Optometric Services Coverage and Limitations Handbook. The following changes were made to the handbook update.
Page 2-4, Visual Examinations, Visual Exam in Conjunction With a Child Health Check-Up, first sentence, we added that Medicaid does not reimburse procedure code 92083 (threshold visual field) when it is performed in conjunction with or on the same date of service as any of the Child Health Check-Up procedure codes.
Page 2-5, Visual Examinations, Visual Exams Related to Providing Eyeglasses in a Nursing Facility, ICF/DD, Recipient’s Home, or Custodial Care Facility, second bullet, we rewrote the instructions for verbal orders to bring them into compliance with Rule 59A-4.107, F.A.C. The revised bullet reads, “The medical need for the exception is ordered by the recipient’s primary-care physician and is documented in the recipient’s medical record at both the facility and the optometric provider’s office. The physician’s order is valid up to 90 days after the order is given. If additional care is needed by the provider, then another order must be written by the recipient’s primary care physician. Pursuant to Rule 59A-4.107, F.A.C., the order may be given verbally by the licensed nurse or attending physician at the facility. The verbal order, including telephone orders, shall be immediately recorded, dated, and signed by the person receiving the order. All verbal treatment orders shall be countersigned by the primary care physician on the next visit to the facility and must be filed in the recipient’s medical record at both the facility and the optometric provider’s office.”
Page 2-5, Visual Examinations, Visual Exams Related to Providing Eyeglasses in a Nursing Facility, ICF/DD, Recipient’s Home, or Custodial Care Facility, last sentence, we deleted “includes refractions,” because Medicaid will reimburse refractions performed in a facility or home setting. The sentence now reads, “General and special ophthalmological services procedure codes are not reimbursable when performed in a facility or home setting.”
Page 2-6, Visual Examinations, Refractions, forth paragraph, we revised the sentence to read, “Medicaid reimburses refractions performed in a provider’s office, an ICF/DD, a recipient’s home, a nursing facility, and a custodial care facility.”
Page 2-6, Visual Examinations, Computerized Corneal Topography, we added that Medicaid reimburses procedure code 92025.
Page 2-8, Evaluation and Management Services, Home Visits, forth paragraph, we added refractions. The sentence now reads, “Medicaid does not reimburse optometrists for other services provided in a recipient’s home except for refractions and the home visit evaluation and management codes listed on the Optometric Services Fee Schedule.”
We added page 2-11 to the handbook update. On page 2-11, Custodial Care Facility Services, Excluded Services, second paragraph, we added refractions. The sentence now reads, “Medicaid does not reimburse optometrists for services provided in a custodial care facility except for refractions and the evaluation and management services as outlined in the evaluation and management section of the CPT.”
We added page 2-13 to the handbook update. On page 2-13, Nursing Facility and ICF/DD Services, Excluded Services, second paragraph, we added refractions. The sentence now reads, “Medicaid does not reimburse optometrists for additional services provided in a nursing care facility or ICF/DD except for refractions and the nursing facility evaluation and management procedures as outlined in the evaluation and management section of the CPT.”
In addition to the above changes, we made the following technical changes. We added the title of the handbook to the header on the Chapter 2 pages and changed the footer date to January 2007 on pages 2-10, 2-11, and 2-13.
