| Description | Code | Allowed Amount |
|---|---|---|
NEW PATIENT COMPLETE EXAM OF VISUAL SYSTEM |
92004:U5 |
$137.12 |
NEW PATIENT PROBLEM FOCUSED EXAM OF VISUAL SYSTEM |
92002:U5 |
$78.05 |
ESTABLISHED PATIENT COMPLETE EXAM OF VISUAL SYSTEM |
92014:U5 |
$114.99 |
ESTABLISHED PATIENT PROBLEM FOCUSED EXAM OF VISUAL SYSTEM |
92012:U5 |
$81.19 |
TEST TO DETERMINE IF PRESCRIPTION EYE WEAR IS NEEDED |
92015 |
$18.64 |
Medicaid Services Update
To: All ADvantage Case Managers
Subject: Additional Information on Waiver Vision Services
Date: March 9, 2022
The response to Vision and Hearing services by those provider types has been overwhelmingly positive, and through their experience we have gained some additional knowledge. New codes have been added to the Word Merge orders in Harmony to address their recommendations. Please begin using the updated form which will be made live at the time this bulletin is sent.
The new service codes address additional types of vision exams. The Case Manager (CM) will need to verify with the provider which code(s) are needed for the initial eye exam so they may claim for the appropriate service(s) once authorized. The Word Merge Form/order is not needed to request an exam. The CM need only enter the service code(s) requested by the provider along with the appropriate Identified Needs. The signed Word Merge Form will be required, however, when requesting prescribed equipment after the exam.
We have included a flyer with this bulletin that can be shared with providers should they have questions or if they would like more information.
The CM should communicate to the Member and the provider after the requested services have been authorized so appointments can be scheduled. After a service is authorized in Harmony, the provider should be able to see the prior authorization (PA) for the services/equipment within the Oklahoma Health Care Authority (OHCA) portal the next day. These authorizations must be in place before the provider conducts the exam or dispenses the prescribed equipment.
Thank you to all Case Managers that that have already initiated this process! If you have any questions regarding the information provided above, please feel free to contact us via Harmony Provider Question.
COMMUNITY LIVING, AGING AND PROTECTIVE SERVICES (CAP
MEDICAID SERVICES UNIT (MSU)
ADvantage Administration | State Plan Care Unit | Medical Eligibility Services
Office: 918-933-4900 | CareLine: 800-435-4711
Last Modified on
Apr 21, 2022
