Cataract/Ocular Surgery

Cataract/Ocular Surgery A. Medicaid covers eyeglasses, including the frames and lenses for beneficiaries who have had surgery on the eyeball or ocular muscle. The surgical benefit will be applied, regardless of whether the beneficiary has received eyeglasses during the benefit period, when all of the following criteria are met: 1. Surgery results in a vision change, 2. Eyeglasses are medically indicated within six (6) months of the surgery, and 3. Eyeglasses are prescribed by an optometrist or ophthalmologist. B. Beneficiaries who undergo multiple surgeries will be eligible for the benefit following each surgery if all criteria is met. C. Beneficiaries who experience refractive changes after the six (6) month post-surgical period are subject to the eyeglass benefit limitations. D. Medicaid does not cover refractive surgery including, but not limited to: 1. Lasik surgery, 2. Radial keratotomy, 3. Photorefractive keratectomy, or 4. Astigmatic keratotomy. E. Beneficiaries who undergo the procedures listed in Rule 3.3 D above cannot receive the surgical benefit. Beneficiaries who need eyeglasses following any of these surgeries are subject to the eyeglass benefit limitations.