Service Limitations: Tinted Lenses

(A) The MassHealth agency pays for "pink l" and "pink 2" colored lenses, up to 25% absorption or equal-density tint, if at least one of the following conditions applies: (1) the member has a pathological or other abnormal condition such as aphakia; or (2) the member has habitually worn tinted lenses of this nature, and the prescriber concludes that the member should continue to wear them. The MassHealth agency does not pay for tinted lenses prescribed only because the member complains of photophobia. (B) Any condition that warrants the use of tinted lenses must be fully documented in the member’s medical record. (C) In some situations, other tints (available for plastic lenses only) may be medically justified. Any condition that warrants the use of tinted lenses of this nature must be fully documented in the member's medical record, and may be ordered from the optical supplier only after the provider has received prior authorization from the MassHealth agency. (130 CMR 402.430 Reserved)