Service Exclusions

(A) The MassHealth agency does not pay for any of the following services or materials: (1) absorptive lenses of greater than 25% absorption; (2) prisms obtained by decentration; (3) non-medical interventions; (4) routine adjustments or follow-up visits to check visual acuity and ocular comfort (payment for such visits is included in the dispensing fee for six months after the date on which the eyeglasses were dispensed); (5) contact lenses for extended-wear use; (6) invisible bifocals/no line progressive lenses; and (7) substitutions. (B) (1) If a member desires a substitute for, or a modification of, a reimbursable item, such as designer frames, the member must pay for the entire cost of the eyeglasses, including dispensing fees. The MassHealth agency does not pay for a portion of the cost of the eyeglasses. In all such instances, the provider must inform the member of the availability of reimbursable items before dispensing nonreimbursable items. (2) It is unlawful (M.G.L. c. 6A, § 35) for a provider to accept any payment from a member for a service or item for which payment is available under MassHealth. If a member claims to have been misinformed about the availability of reimbursable items, it will be the responsibility of the provider to prove that the member was offered a reimbursable item, refused it, and chose instead to accept and pay for a nonreimbursable item.