405 IAC 5-23-2 Initial examinations

Sec. 2. (a) Reimbursement for the initial vision care examination will be limited to: (1) one (1) examination per year for a member under twenty-one (21) years of age; and (2) one (1) examination every two (2) years for a member twenty-one (21) years of age or older. If more frequent examination or care is medically necessary, documentation supporting such medically necessary determinations must be maintained in the provider's office. The documentation shall be subject to postpayment review and audit. (b) An initial examination is the initial vision care service performed for the determination of the need for additional vision care services. The type of initial exam given must be medically necessary. The frequency of vision care services is subject to the limitations listed in subsection (a). The initial examination may include the following: (1) An eye examination, including history. (2) Visual acuity determination. (3) External eye examination. (4) Biocular measure. (5) Routine ophthalmoscopy. (6) Tonometry and gross visual field testing, including: (A) color vision; (B) depth perception; or (C) stereopsis.