Medicaid Benefits: Eyeglasses and Other Visual Aids
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 33 No - 13 NR - 5 | 2018 data limited to CN | Yes - 11 | Yes - 28 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes | CN | No | Limit of one visit every 3 calendar years | - | - |
| Alaska | Yes | CN | No | Must be prior authorized | - | - |
| Arizona | Yes | CN | No | Limited to eye glasses and contact lenses as the sole prosthetic after cataract extraction | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | No | - | - | |||
| Colorado | Yes | CN | No | after eye surgery only | - | - |
| Connecticut | Yes | CN | No | One pair of glasses per member every two years unless medically necessary. Prescription sunglasses will be covered if light sensitivity hinders outdoor activities. Trifocals will be covered for extenuating circumstances. Oversize lens will covered for physiological reasons and cosmetic reasons. | - | - |
| Delaware | No | - | - | |||
| District of Columbia | Yes | CN | $1.00/service | Eyeglasses are limited to one pair per 24 month period for adults unless exception applies; Contact lenses require PA | - | - |
| Florida | Yes | CN | No | Two pairs of eyeglasses per 365 days for recipients under the age of 21 years. For recipients age 21 years and older, Florida Medicaid reimburses for the following: One frame every two years; Two lenses every 365 days. Florida Medicaid reimburses for the following when the recipient has a documented medical condition where eyeglasses would not provide any benefit for their visual impairment: Rigid or soft contact lenses; Extended wear (if the recipient cannot wear normal soft lenses). Contact lens services include all of the following: Fitting; The contact lens and required care kits; Instructions on insertion, removal, and proper care of the lenses; A 90 day follow-up visit period that includes acuities, assessment of corneal physiology, biomicroscopy examination, and other procedures required (as necessary). Florida Medicaid reimburses for evaluating, measuring, fitting, and dispensing of the prosthetic eye(s). The evaluation must be completed no more than three months prior to the provision of the prosthetic eye. | - | - |
| Georgia | Yes | CN | $3 copay | Medical necessity. | - | - |
| Hawaii | No | - | - | |||
| Idaho | Yes | CN | No | Limited to post-cataract surgery lenses or for an acute or chronic condition that without treatment could result in permanent damage to the eye | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | 1 pair eyeglasses/5 years, age specific minimum diopter correction required for initial and replacement eyeglasses. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $2.00 per service date | 1 pair every 4 years | - | - |
| Kentucky | No | - | - | |||
| Louisiana | No | - | - | |||
| Maine | Yes | CN | $.50 to $2/day depending on payment amount, up to $20/month | 1 pair of eyeglasses/lifetime | - | - |
| Maryland | No | - | - | |||
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | $2/dispensing service | One pair of replacement eyeglasses per year. A routine eye exam once every two years without PA. | - | - |
| Minnesota | Yes | CN | No | No | - | - |
| Mississippi | Yes | CN | $3 per pair of eyeglasses | 1 pair of eyeglasses every 5 years | - | - |
| Missouri | Yes | CN | No | Traditional Medicaid Adults are allowed one set of eyeglasses or other visual aids one time every two years. (Both frames and lens(es).) | - | - |
| Montana | Yes | CN | No | One pair of eyeglasses every 2 years | - | - |
| Nebraska | Yes | CN | $2 per eyeglasses | One pair of eyeglass frames every 24 months; some frame specifications are not covered | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | Yes | CN | No | NR | - | - |
| New Jersey | Yes | CN | No | quantity limits, prior authorization | - | - |
| New Mexico | Yes | CN | No | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | No | - | - | |||
| North Dakota | Yes | CN | No | 1 pair every 2 years, broken eyeglasses must be repaired if possible | - | - |
| Ohio | Yes | CN | Vision care services are subject to copay of $2 per date of service for the following general ophthalmological services: medical examination and evaluation with initiation or continuation of diagnostic and treatment program; $1 per date of service for the following dispensing services: fitting of spectacles except for aphakia | 1 complete set of eyeglasses every 12 or 24 months depending on individual's age without PA | - | - |
| Oklahoma | No | - | - | |||
| Oregon | Yes | CN | No | Routine exams limited to pregnant women | - | - |
| Pennsylvania | Yes | CN | Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80 | Limited to individuals with diagnosis of aphakia - 4 lenses per calendar year; 2 frames per calendar year. Contact lenses limited to individuals with diagnosis of aphakia - 4 lenses per calendar year. Low vision aids limited to 1 per 2 calendar years. | - | - |
| Rhode Island | Yes | CN | No | Policy has time limits for replacement. | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | $2/lens, frame or repair | 1 pair of glasses covered once every 15 months plus one day if a new pair is necessary. New lenses can be replaced early if diopter correction criteria met. Contact lenses covered only when medically necessary for certain conditions. | - | - |
| Tennessee | Yes | CN | No | Limited to 1 pair of post-cataract surgery lenses or eyeglasses. | - | - |
| Texas | Yes | CN | No | Requires prior authorization. | - | - |
| Utah | No | - | - | |||
| Vermont | No | - | - | |||
| Virginia | No | - | - | |||
| Washington | No | - | - | |||
| West Virginia | Yes | CN | No | One pair of eyeglasses/frames is covered for members who had documented cataract extraction within the past 60 days | - | - |
| Wisconsin | Yes | CN | $0.50 - $3.00 per service; no copayment for frames ordered from the state's volume purchase contractor | One pair of eyeglasses/year and one replacement per year, without prior approval. Non-contracted items and items purchased outside of the state's volume purchase contract require prior approval | - | - |
| Wyoming | No | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 46 No - 10 | Yes - 14 No - 32 | ||||
| Alabama | Yes | CN | 1 pair eyeglasses/3 years | Additional eyeglasses based on medical necessity | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Alaska | Yes | CN | 1 pair eyeglasses/year | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| American Samoa | Yes | See territory-specific FN | Correction must be below plus or minus .50 diopters or 10 cylinder axis and 1 pair of new or repaired eyeglasses/2 years; contact lenses not covered | |||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery items | Fee for service | ||
| Arkansas | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/year, contact lenses limited to post-cataract surgery | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| California | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses not covered, interim replacement for lost or broken eyeglasses allowed once in 2 years, coverage limited to pregnant or institutionalized adults | Yes | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Colorado | Yes | CN | Limited to post-surgery lenses and eyeglasses | Fee for service | ||
| Connecticut | Yes | CN & MN | 1 pair/2 years; lost, stolen or broken eyeglasses not replaced; special lenses covered when specified criteria met | Specified services | Fee for service | |
| Delaware | No | |||||
| District of Columbia | Yes | CN & MN | $2/service | 1 pair eyeglasses/2 years, minimum diopter correction required | Fee for service | |
| Florida | Yes | CN & MN | Eyeglasses, contact lenses and prosthetic eyes for specified medical conditions, 2 pair eyeglass lenses/year and 1 pair eyeglass frames/2 years | Specified items | Fee for service | |
| Georgia | Yes | CN & MN | Adult coverage limited to nursing facility residents with specific physician order, minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Guam | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service up to $80 maximum for single vision lenses and $128 for bifocals | |
| Hawaii | Yes | CN & MN | 1 pair eyeglasses/2 years unless vision change exceeding specified diopter criteria is met, special lenses limited by medical condition | Contact lenses, visual aids costing more than $50 | Fee for service | |
| Idaho | Yes | CN | Limited to post-cataract surgery lenses or for an acute or chronic condition that without treatment could result in permanent damage to the eye | Yes | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Illinois | Yes | CN & MN | 1 pair eyeglasses/2 year with specified exceptions | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Indiana | Yes | CN | 1 pair eyeglasses/5 years, age-specific minimum diopter correction required for initial and replacement eyeglasses | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day for optometrist or optician service | 1 pair eyeglasses/2 years unless specific criteria met, contact lenses for specified conditions, special lenses covered if specified criteria met | Specified services | Fee for service |
| Kansas | Yes | CN & MN | $2/date of service | 1 pair eyeglasses/4 years, post-cataract surgery lenses and eyeglasses covered for 1 year | Contact lenses | Reasonable charge with limits |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month when provided by optician | 1 pair eyeglasses/lifetime, minimum diopter correction required, contact lenses not covered | Specified items and services | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | 1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions | Specified services/items including special lenses and low-vision aids | Fee for service | |
| Michigan | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses | Most products, excluding contact lenses, provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | $3/optician visit, B - $25/pair | 1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Mississippi | Yes | CN | $3/pair | 1 pair eyeglasses/5 years | Acquisition cost | |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | 1 pair eyeglasses/2 years, replacement of lenses only if specified diopter criteria met | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | A - 1 pair eyeglasses/2 years unless post-cataract surgery or minimum diopter correction criteria met ; B - Limited to post-cataract surgery lenses or eyeglasses and to eyeglasses essential for employment or related to specified medical conditions including diabetes | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Nebraska | Yes | CN & MN | $2/pair | Minimum diopter correction required for initial and replacement eyeglasses, replacements one/2 years and only if eyeglasses lost or unusable, contact lenses for specified medical conditions | Fee for service | |
| Nevada | Yes | CN | 1 pair eyeglasses/year | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 pair eyeglasses/year if minimum .50 diopter correction criteria met in both eyes, one repair/year | Fee for service | ||
| New Jersey | Yes | CN & MN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 19-59 | Fee for service | ||
| New Mexico | Yes | CN | 1 pair/3 years, replacement of lost or broken pairs only covered for developmentally disabled adults; A - benefit limited to eyeglasses or contact lenses required after cataract surgery | Acquisition cost with ceilings | ||
| New York | Yes | CN & MN | 1 pair eyeglasses/2 years | Special lenses and other specified services | Fee for service | |
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | 1 pair/2 years, broken eyeglasses must be repaired if possible | Most products provided by state's volume purchase contractor with dispensing provider paid fee for service, provider paid fee for service for product if secondary to Medicare payment and following cataract surgery | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 pair eyeglasses/2 years | Yes | ||
| Ohio | Yes | CN | $1/date of service for dispensing | 1 pair eyeglasses/2 years for age 21-59,1 pair/year for over age 59, specified diopter criteria must be met | Specified services, including contact lenses and items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Oklahoma | No | |||||
| Oregon | Yes | A & B - See state-specific FN | Adult coverage limited to pregnant women and specified medical conditions; 1 pair eyeglasses/2 years; contact lenses if specified criteria met | Items not from state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, acquisition cost for other items | |
| Pennsylvania | Yes | CN & MN | $.65-$3.80/service, depending on payment rate | Adult coverage limited to diagnosis of aphakia | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | 1 pair eyeglasses/2 years | Negotiated fee for eyeglass frames, industry provided price list for lenses | ||
| South Carolina | Yes | CN | Limited to eyeglasses required as a result of treating a visual system disorder, eyeglasses for general vision correction not covered | Yes | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| South Dakota | Yes | CN | $2/lens, frame or repair | 1 pair eyeglasses/15 months if minimum diopter correction criteria met, contact lenses covered only when medically necessary for certain conditions | Fee for service | |
| Tennessee | Yes | A, B & C - See state-specific FN | Limited to 1 pair of post-cataract surgery lenses or eyeglasses | See state-specific FN | ||
| Texas | Yes | CN & MN | 1 pair eyeglasses/2 years if minimum diopter correction and axis change criteria met | Yes | Fee for service | |
| Utah | Yes | A & C - See state-specific FN | Adult coverage limited to pregnant women | Fee for service or capitated rate | ||
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Annual prescription must be written by public health facility physician | Fee for service | ||
| Virginia | No | |||||
| Washington | No | |||||
| West Virginia | Yes | A, B & C | 1 pair eyeglasses following cataract surgery | Specified items and services | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | 1 pair eyeglasses/year and 1 replacement/year if eyeglasses lost or broken | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, average acquisition cost for other items |
| Wyoming | Yes | CN | Limited to post-cataract surgery lenses | Contact lenses | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 49 No - 7 | Yes - 15 No - 34 | ||||
| Alabama | Yes | CN | 1 pair eyeglasses/2 years | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Alaska | Yes | CN | 1 pair eyeglasses/year | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery items | Fee for service | ||
| Arkansas | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/year, contact lenses limited to post-cataract surgery | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| California | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses not covered, interim replacement for lost or broken eyeglasses allowed once in 2 years, coverage limited to pregnant or institutionalized adults | Yes | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Colorado | Yes | CN | Limited to post-surgery lenses and eyeglasses | Fee for service | ||
| Connecticut | Yes | CN & MN | Special lenses covered when specified criteria met | Specified services | Fee for service | |
| Delaware | Yes | CN | Routine vision care not covered, benefit limited to aphakic or bandage lenses following cataract surgery | Yes | Fee for service | |
| District of Columbia | Yes | CN & MN | $2/service | 1 pair eyeglasses/2 years, minimum diopter correction required | Fee for service | |
| Florida | Yes | CN & MN | Eyeglasses, contact lenses and prosthetic eyes for specified medical conditions, 2 pair eyeglass lenses/year and 1 pair eyeglass frames/2 years | Specified items | Fee for service | |
| Georgia | Yes | CN & MN | Adult coverage limited to nursing facility residents with specific physician order, minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Guam | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service up to $80 maximum for single vision lenses and $128 for bifocals | |
| Hawaii | Yes | CN & MN | 1 pair eyeglasses/2 years unless vision change exceeding specified diopter criteria is met, special lenses limited by age and medical condition | Contact lenses, visual aids costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 1 pair eyeglass frames/4 years, minimum diopter correction required for initial and replacement eyeglass lenses, replacement not covered for lost or broken eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Illinois | Yes | CN & MN | 1 pair eyeglasses/year with specified exceptions | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Indiana | Yes | CN | 1 pair eyeglasses/2 years, age-specific minimum diopter correction required for initial and replacement eyeglasses | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 pair eyeglasses/2 years unless specific criteria met, contact lenses for specified post-surgery conditions, special lenses covered if specified criteria met | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 pair eyeglasses/4 years, post-cataract surgery lenses and eyeglasses covered for 1 year | Contact lenses | Reasonable charge with limits |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | 1 pair eyeglasses/lifetime, minimum diopter correction required, contact lenses not covered | Specified items and services | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | 1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions | Specified services/items including special lenses and low-vision aids | Fee for service | |
| Michigan | Yes | CN & MN | $2/dispensing service | Limited to low-vision supplies only, including eyeglasses, contact lenses, optical devices and other low-vision aids; qualifying diagnosis must be present | Selected procedures | Most products, excluding contact lenses, provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Minnesota | Yes | A & B - See state-specific FN | B - $25/pair - See state-specific FN | 1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals | Fee for service | |
| Mississippi | Yes | CN | $3/pair | 1 pair eyeglasses/5 years | Acquisition cost | |
| Missouri | Yes | CN | $.50-$3/item or service, depending on payment | 1 pair eyeglasses/2 years, replacement of lenses only if specified diopter criteria met | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | A - 1 pair eyeglasses/2 years unless post-cataract surgery or minimum diopter correction criteria met B - Limited to post-cataract surgery lenses or eyeglasses and to eyeglasses essential for employment or related to specified medical conditions including diabetes | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Nebraska | Yes | CN & MN | $2/pair | Minimum diopter correction required for initial and replacement eyeglasses, replacements one/2 years and only if eyeglasses lost or unusable, contact lenses for specified medical conditions | Fee for service | |
| Nevada | Yes | CN | 1 pair eyeglasses/year | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 pair eyeglasses/year if minimum .50 diopter correction criteria met in both eyes, one repair/year | Fee for service | ||
| New Jersey | Yes | CN & MN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 19-59 | Acquisition cost with ceilings | ||
| New Mexico | Yes | CN | 1 pair/3 years, replacement of lost or broken pairs only covered for developmentally disabled adults; A - benefit limited to eyeglasses or contact lenses required after cataract surgery | Acquisition cost with ceilings | ||
| New York | Yes | CN & MN | 1 pair eyeglasses/2 years | Special lenses and other specified services | Fee for service | |
| North Carolina | Yes | CN & MN | $2/pair and for supplies or repairs costing more than $5 | 1 pair eyeglasses/2 years, minimum diopter correction criteria, repairs costing less than $5 not covered | Yes | Most products provided by state's volume purchase contractor, dispensing fee paid fee for service |
| North Dakota | Yes | CN & MN | 1 pair/2 years, broken eyeglasses must be repaired if possible, replacement of hard contact lenses allowed only if beneficiary had them prior to Medicaid eligibility | Fee for service for eyeglass frames, acquisition cost for lenses | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 pair eyeglasses/2 years | Yes | ||
| Ohio | Yes | CN | $1/date of service for dispensing | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 21-59, specified diopter criteria must be met | Specified services, including contact lenses and items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Oklahoma | No | |||||
| Oregon | Yes | A & B - See state-specific FN | Adult coverage limited to pregnant women and specified medical conditions; 1 pair eyeglasses/2 years; contact lenses if specified criteria met | Items not from state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, acquisition cost for other items | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | Adult coverage limited to diagnosis of aphakia | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | 1 pair eyeglasses/2 years | Negotiated fee for eyeglass frames, industry provided price list for lenses | ||
| South Carolina | Yes | CN | Limited to non-refractive care and services unrelated to corrective vision | Yes | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| South Dakota | Yes | CN | $2/lens, frame or repair | 1 pair eyeglasses/15 months if minimum diopter correction criteria met, 2 replacement contact lenses/year | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to 1 pair of post-cataract surgery lenses or eyeglasses | See state-specific FN | ||
| Texas | Yes | CN & MN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service | |
| Utah | Yes | A & C - See state-specific FN | Adult coverage limited to pregnant women | Fee for service | ||
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Annual prescription must be written by public health facility physician | Fee for service | ||
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 pair eyeglasses/2 years except 1 pair eyeglasses/year for developmentally disabled | 2 pair eyeglasses rather than bifocals | Fee for service | |
| West Virginia | Yes | A, B & C | 1 pair eyeglasses following cataract surgery | Specified items and services | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | 1 pair eyeglasses/year and 1 replacement/year if eyeglasses lost or broken | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, average acquisition cost for other items |
| Wyoming | Yes | CN | Limited to post-cataract surgery lenses | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 48 No - 8 | Yes - 16 No - 32 | ||||
| Alabama | Yes | CN | 1 pair eyeglasses/2 years | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Alaska | Yes | CN | 1 pair eyeglasses/year | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery items | Fee for service | ||
| Arkansas | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/year, contact lenses limited to post-cataract surgery | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| California | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses not covered, interim replacement for lost or broken eyeglasses allowed once in 2 years | Yes | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Colorado | Yes | CN | Limited to post-surgery lenses and eyeglasses | Fee for service | ||
| Connecticut | Yes | CN & MN | Special lenses covered when specified criteria met | Specified services | Fee for service | |
| Delaware | Yes | CN | Limited to aphakic or bandage lenses following cataract surgery | Yes | Fee for service | |
| District of Columbia | Yes | CN & MN | $2/service | 1 pair eyeglasses/2 years, minimum diopter correction required | Fee for service | |
| Florida | Yes | CN & MN | Eyeglasses, contact lenses and prosthetic eyes for specified medical conditions, 2 pair of eyeglasses/year | Specified items | Fee for service | |
| Georgia | Yes | CN & MN | Adult coverage limited to nursing facility residents with specific physician order, minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Guam | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service up to $80 maximum for single vision lenses and $128 for bifocals | |
| Hawaii | Yes | CN & MN | 1 pair eyeglasses/2 years unless vision change exceeding specified diopter criteria is met, special lenses limited by age and medical condition | Contact lenses, visual aids costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 1 pair eyeglass frames/4 years, minimum diopter correction required for initial and replacement eyeglass lenses; replacement not covered for lost or broken eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Illinois | Yes | CN & MN | 1 pair eyeglasses/year with specified exceptions | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Indiana | Yes | CN | 1 pair eyeglasses/2 years, age-specific minimum diopter correction required for initial and replacement eyeglasses | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 pair eyeglasses/2 years unless specific criteria met, contact lenses for specified post-surgery conditions, special lenses covered if specified criteria met | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 pair eyeglasses/4 years, post-cataract surgery lenses and eyeglasses covered for 1 year | Contact lenses | Reasonable charge with limits |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | 1 pair eyeglasses/lifetime, minimum diopter correction required, contact lenses not covered | Specified items and services | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | 1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions | Specified services/items including special lenses and low-vision aids | Fee for service | |
| Michigan | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions, oversized and progressive or transition lenses not covered | Selected procedures | Most products, excluding contact lenses, provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Minnesota | Yes | A & B - See state-specific FN | A - $3/pair, B - $25/pair - See state-specific FN | 1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals | Fee for service | |
| Mississippi | Yes | CN | $3/pair | 1 pair eyeglasses/5 years | Acquisition cost | |
| Missouri | Yes | CN | $.50-$3/item or service, depending on payment | 1 pair eyeglasses/2 years, replacement of lenses only if specified diopter criteria met | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/pair | A - 1 pair eyeglasses/2 years unless post-cataract surgery or minimum diopter correction criteria met B - Limited to post-cataract surgery lenses or eyeglasses and to eyeglasses essential for employment or related to specified medical conditions including diabetes | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Nebraska | Yes | CN & MN | $2/pair | Minimum diopter correction required for initial and replacement eyeglasses, replacements one/2 years and only if eyeglasses lost or unusable, contact lenses for specified medical conditions | Fee for service | |
| Nevada | No | |||||
| New Hampshire | Yes | CN & MN | 1 pair eyeglasses/year if minimum .50 diopter correction criteria met in both eyes, one repair/year | Fee for service | ||
| New Jersey | Yes | CN & MN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 19-59 | Acquisition cost with ceilings | ||
| New Mexico | Yes | CN | 1 pair/2 years, replacement of lost or broken pairs only covered for developmentally disabled adults | Acquisition cost with ceilings | ||
| New York | Yes | CN & MN | 1 pair eyeglasses/2 years | Special lenses and other specified services | Fee for service | |
| North Carolina | Yes | CN & MN | $2/pair and for supplies or repairs costing more than $5 | 1 pair eyeglasses/2 years, minimum diopter correction criteria, repairs costing less than $5 not covered | Yes | Most products provided by state's volume purchase contractor, dispensing fee paid fee for service |
| North Dakota | Yes | CN & MN | 1 pair/3 years, broken eyeglasses must be repaired if possible, replacement of hard contact lenses allowed only if beneficiary had them prior to Medicaid eligibility | Fee for service for eyeglass frames, acquisition cost for lenses | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 pair eyeglasses/2 years | Yes | ||
| Ohio | Yes | CN | $1/date of service for dispensing | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 21-59, specified diopter criteria must be met | Specified services, including contact lenses and items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | 1 pair eyeglasses/2 years; contact lenses if specified criteria met; multiple pairs, special lenses and low vision aids not covered | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, acquisition cost for other items | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | Adult coverage limited to diagnosis of aphakia | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN - see state-specific FN | 1 pair eyeglasses/2 years | Negotiated fee for eyeglass frames, industry provided price list for lenses | ||
| South Carolina | Yes | CN | Limited to post-cataract, retinal, corneal or glaucoma surgery lenses and eyeglasses | Yes | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| South Dakota | Yes | CN | $2/lens, frame or repair | 1 pair eyeglasses/15 months if minimum diopter correction criteria met, 2 replacement contact lenses/year | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to 1 pair of post-cataract surgery lenses or eyeglasses | |||
| Texas | Yes | CN & MN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service | |
| Utah | Yes | A & C - See state-specific FN | A - adult coverage limited to pregnant women, C - coverage limited to post-cataract surgery contact lenses | Fee for service | ||
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Annual prescription must be written by public health facility physician | Fee for service | ||
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 pair eyeglasses/2 years except 1 pair eyeglasses/year for developmentally disabled | 2 pair eyeglasses rather than bifocals | Fee for service | |
| West Virginia | Yes | A, B & C | 1 pair eyeglasses following cataract surgery | Specified items and services | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | 1 pair eyeglasses/year and 1 replacement/year if eyeglasses lost or broken | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, average acquisition cost for other items |
| Wyoming | Yes | CN | Limited to post-cataract surgery lenses | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 49 No - 7 | Yes - 16 No - 33 | ||||
| Alabama | Yes | CN | 1 pair eyeglasses/2 years | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Alaska | Yes | CN | 1 pair eyeglasses/year | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery items | Fee for service | ||
| Arkansas | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/2 years, contact lenses limited to post-cataract surgery | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| California | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses not covered, interim replacement for lost or broken eyeglasses allowed once in 2 years | Yes | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Colorado | Yes | CN | Limited to post-surgery lenses and eyeglasses | Fee for service | ||
| Connecticut | Yes | CN & MN | Special lenses covered when specified criteria met | Specified services | Fee for service | |
| Delaware | Yes | CN | Limited to aphakic or bandage lenses following cataract surgery | Yes | Fee for service | |
| District of Columbia | Yes | CN & MN | $2/service | 1 pair eyeglasses/2 years, minimum diopter correction required | Fee for service | |
| Florida | Yes | CN & MN | Eyeglasses, contact lenses and prosthetic eyes for specified medical conditions, 2 pair of eyeglasses/year | Yes | Fee for service | |
| Georgia | Yes | CN & MN | Adult coverage limited to nursing facility residents with specific physician order, minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Guam | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service up to $80 maximum for single vision lenses and $128 for bifocals | |
| Hawaii | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses limited by age and medical condition | Fee for service | ||
| Idaho | Yes | CN | 1 pair eyeglasses/4 years, minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Illinois | Yes | CN & MN | 1 pair eyeglasses/year with specified exceptions | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Indiana | Yes | CN | 1 pair eyeglasses/2 years, age-specific minimum diopter correction required for initial and replacement eyeglasses | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 pair eyeglasses/2 years unless specific criteria met, contact lenses for specified post-surgery conditions, special lenses covered if specified criteria met | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 pair eyeglasses/4 years, post-cataract surgery lenses and eyeglasses covered for 1 year | Contact lenses | Reasonable charge with limits |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | 1 pair eyeglasses/lifetime, minimum diopter correction required, contact lenses not covered | Specified items and services | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | 1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions | Specified services/items including special lenses and low-vision aids | Fee for service | |
| Michigan | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | A - $3/pair, B - $25/pair - See state-specific FN | 1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals | Fee for service | |
| Mississippi | Yes | CN | $3/pair | 1 pair eyeglasses/5 years | Acquisition cost | |
| Missouri | Yes | CN | $.50-$3/item or service, depending on payment | 1 pair eyeglasses/2 years | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/pair | A - 1 pair eyeglasses/2 years unless post-cataract surgery or minimum diopter correction criteria met B - Limited to post-cataract surgery lenses or eyeglasses and to eyeglasses essential for employment or related to specified medical conditions including diabetes | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Nebraska | Yes | CN & MN | $2/pair | Minimum diopter correction required for initial and replacement eyeglasses, replacements 1/year and only if eyeglasses lost or unusable, contact lenses for specified medical conditions | Fee for service | |
| Nevada | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 pair eyeglasses/year if minimum diopter correction criteria met, limit also applies to replacements and repairs | Fee for service | ||
| New Jersey | Yes | CN & MN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 19-59 | Acquisition cost with ceilings | ||
| New Mexico | Yes | CN | 1 pair/2 years, replacement of lost or broken pairs only covered for developmentally disabled adults | Acquisition cost with ceilings | ||
| New York | Yes | CN & MN | 1 pair eyeglasses/2 years | Special lenses and other specified services | Fee for service | |
| North Carolina | Yes | CN & MN | $2/pair and for supplies or repairs costing more than $5 | Minimum diopter correction criteria, repairs costing less than $5 not covered, limited frame selection | Yes | Most products provided by state's volume purchase contractor, dispensing fee is negotiated rate |
| North Dakota | Yes | CN & MN | 1 pair/3 years, broken eyeglasses must be repaired if possible, replacement of hard contact lenses allowed only if beneficiary had them prior to Medicaid eligibility | Fee for service for eyeglass frames, acquisition cost for lenses | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 pair eyeglasses/2 years | Yes | ||
| Ohio | Yes | CN | $1/dispensing visit | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 21-59, specified diopter criteria must be met | Specified services, including items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | 1 pair eyeglasses/2 years; contact lenses if specified criteria met; multiple pairs, special lenses and low vision aids not covered | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, acquisition cost for other items | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment | Limited to post-cataract lenses | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN - see state-specific FN | 1 pair eyeglasses/2 years | Negotiated fee for eyeglass frames, industry provided price list for lenses | ||
| South Carolina | Yes | CN | Limited to post-cataract surgery lenses and eyeglasses | Yes | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| South Dakota | Yes | CN | $2/lens, frame or repair | 1 pair eyeglasses/15 months if minimum diopter correction criteria met, 2 replacement contact lenses/year | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to 1 pair of post-cataract surgery lenses or eyeglasses | |||
| Texas | Yes | CN & MN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Fee for service | ||
| Utah | Yes | A & C - See state-specific FN | A - adult coverage limited to pregnant women, C - coverage limited to post-cataract surgery contact lenses | Fee for service | ||
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Annual prescription must be written by public health facility physician | Fee for service | ||
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 pair eyeglasses/2 years except 1 pair eyeglasses/year for developmentally disabled | 2 pair eyeglasses rather than bifocals | Fee for service | |
| West Virginia | Yes | CN & MN | 1 pair eyeglasses following cataract surgery | Specified items and services | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | 1 pair eyeglasses/year and 1 replacement/year if eyeglasses lost or broken | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, average acquisition cost for other items |
| Wyoming | Yes | CN | Limited to post-cataract surgery lenses | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 45 No - 11 | Yes - 12 No - 33 | ||||
| Alabama | Yes | CN | 1 pair eyeglasses/2 years | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Alaska | Yes | CN | 1 pair eyeglasses/year | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery items | Fee for service | ||
| Arkansas | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/2 years, contact lenses limited to post-cataract surgery | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| California | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses not covered, interim replacement for lost or broken eyeglasses allowed once in 2 years | Yes | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Colorado | Yes | CN | Limited to post-surgery lenses and eyeglasses | Fee for service | ||
| Connecticut | No | |||||
| Delaware | No | |||||
| District of Columbia | Yes | CN & MN | $2/service | 1 pair eyeglasses/2 years, minimum diopter correction required | Fee for service | |
| Florida | Yes | CN & MN | Contact lenses and prosthetic eyes for specified medical conditions, eyeglasses not covered | Yes | Fee for service | |
| Georgia | Yes | CN & MN | Minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Guam | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service up to $80 maximum for single vision lenses and $128 for bifocals | |
| Hawaii | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses limited by age and medical condition | Fee for service | ||
| Idaho | Yes | CN | 1 pair eyeglasses/4 years, minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Illinois | Yes | CN & MN | 1 pair eyeglasses/year with specified exceptions | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Indiana | Yes | CN | 1 pair eyeglasses/2 years, age-specific minimum diopter correction required for initial and replacement eyeglasses | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 pair eyeglasses/2 years unless specific criteria met, contact lenses for specified post-surgery conditions, special lenses covered if specified criteria met | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 pair eyeglasses/4 years, post-cataract surgery lenses and eyeglasses covered for 1 year | Contact lenses | Reasonable charge with limits |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | 1 pair eyeglasses/lifetime, minimum diopter correction required | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Maryland | No | |||||
| Massachusetts | No | |||||
| Michigan | Yes | CN & MN | 1 pair/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | A - $3/pair, B - $25/pair - See state-specific FN | 1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals | Fee for service | |
| Mississippi | Yes | CN | $3/pair | 1 pair eyeglasses/5 years | Acquisition cost | |
| Missouri | Yes | CN | $.50-$3/item or service, depending on payment | 1 pair eyeglasses/2 years | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/pair | A - 1 pair eyeglasses/2 years unless post-cataract surgery or minimum diopter correction criteria met B - Limited to post-cataract surgery lenses or eyeglasses and to eyeglasses essential for employment or related to specified medical conditions including diabetes | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Nebraska | Yes | CN & MN | $2/pair | Minimum diopter correction required for initial and replacement eyeglasses, replacements 1/year and only if eyeglasses lost or unusable, contact lenses for specified medical conditions | Fee for service | |
| Nevada | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Acquisition cost with ceilings | ||
| New Hampshire | Yes | CN & MN | 1 pair eyeglasses/year if minimum diopter correction criteria met, limit also applies to replacements and repairs | Fee for service | ||
| New Jersey | Yes | CN & MN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 19-59 | Acquisition cost with ceilings | ||
| New Mexico | Yes | CN | 1 pair/2 years, replacement of lost or broken pairs only covered for developmentally disabled adults | Acquisition cost with ceilings | ||
| New York | Yes | CN & MN | 1 pair eyeglasses/2 years | Special lenses and other specified services | Fee for service | |
| North Carolina | Yes | CN & MN | $2/pair and for supplies or repairs costing more than $5 | Minimum diopter correction criteria, repairs costing less than $5 not covered, limited frame selection | Yes | Most products provided by state's volume purchase contractor, dispensing fee is negotiated rate |
| North Dakota | Yes | CN & MN | 1 pair/3 years, broken eyeglasses must be repaired if possible, replacement of hard contact lenses allowed only if beneficiary had them prior to Medicaid eligibility | Fee for service for eyeglass frames, acquisition cost for lenses | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 pair eyeglasses/2 years | Yes | ||
| Ohio | Yes | CN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 21-59 | Specified services including items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | 1 pair eyeglasses/2 years; contact lenses if specified criteria met; multiple pairs, special lenses and low vision aids not covered | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, acquisition cost for other items | |
| Pennsylvania | Yes | CN & MN | MN: limited to services provided in outpatient hospital clinic setting and billed as a clinic service, limited to aphakia and cataract conditions | Fee for service | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN - see state-specific FN | 1 pair eyeglasses/2 years | Negotiated fee for eyeglass frames, industry provided price list for lenses | ||
| South Carolina | Yes | CN | Limited to post-cataract surgery lenses and eyeglasses | Yes | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| South Dakota | Yes | CN | 1 pair eyeglasses/15 months if minimum diopter correction criteria met, 2 replacement contact lenses/year | Fee for service | ||
| Tennessee | Yes | A & B - See state-specific FN | Limited to 1 pair of post-cataract surgery lenses or eyeglasses | |||
| Texas | No | |||||
| Utah | Yes | A & C - See state-specific FN | A - adult coverage limited to pregnant women, C - coverage limited to post-cataract surgery contact lenses | Fee for service | ||
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Annual prescription must be written by public health facility physician | Fee for service | ||
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 pair eyeglasses/2 years except 1 pair eyeglasses/year for developmentally disabled | 2 pair eyeglasses rather than bifocals | Fee for service | |
| West Virginia | Yes | CN & MN | 1 pair eyeglasses following cataract surgery | Specified items and services | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | 1 pair eyeglasses/year and 1 replacement/year if eyeglasses lost or broken | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, average acquisition cost for other items |
| Wyoming | Yes | CN | Limited to post-cataract surgery lenses | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 47 No - 9 | Yes - 12 No - 35 | ||||
| Alabama | Yes | CN | 1 pair eyeglasses/2 years | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Alaska | Yes | CN | 1 pair eyeglasses/year | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery items | Fee for service | ||
| Arkansas | Yes | CN & MN | $2/dispensing service | 1 pair eyeglasses/2 years, contact lenses limited to post-cataract surgery | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| California | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses not covered, interim replacement for lost or broken eyeglasses allowed once in 2 years | Yes | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Colorado | Yes | CN | Limited to post-surgery lenses and eyeglasses | Fee for service | ||
| Connecticut | Yes | CN & MN | Special lenses covered only when specified criteria met | Fee for service or actual acquisition cost | ||
| Delaware | No | |||||
| District of Columbia | Yes | CN & MN | $2/service | 1 pair eyeglasses/2 years, minimum diopter correction required | Fee for service | |
| Florida | Yes | CN & MN | Contact lenses and prosthetic eyes for specified medical conditions, eyeglasses not covered | Yes | Fee for service | |
| Georgia | Yes | CN & MN | Minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Guam | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Yes | Fee for service up to $80 maximum for single vision lenses and $128 for bifocals | |
| Hawaii | Yes | CN & MN | 1 pair eyeglasses/2 years, special lenses limited by age and medical condition | Fee for service | ||
| Idaho | Yes | CN | 1 pair eyeglasses/4 years, minimum diopter correction required for initial and replacement eyeglasses | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Illinois | Yes | CN & MN | 1 pair eyeglasses/year with specified exceptions | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Indiana | Yes | CN | 1 pair eyeglasses/2 years, age-specific minimum diopter correction required for initial and replacement eyeglasses | Fee for service | ||
| Iowa | Yes | CN & MN | 1 pair eyeglasses/2 years unless specific criteria met, contact lenses for specified post-surgery conditions, special lenses covered if specified criteria met | Fee for service | ||
| Kansas | Yes | CN & MN | $2/date of service | 1 pair eyeglasses/4 years if employment-based need, post-cataract surgery lenses and eyeglasses covered for 1 year | Reasonable charge with limits | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | 1 pair eyeglasses/lifetime, minimum diopter correction required | Products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Maryland | No | |||||
| Massachusetts | No | |||||
| Michigan | Yes | CN & MN | 1 pair/2 years, minimum diopter correction required for initial and replacement eyeglasses, replacements within 2 years only if eyeglasses lost or unusable, contact lenses and special lenses for specified medical conditions | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | A - $3/pair, B - $25/pair - See state-specific FN | 1 pair eyeglasses/2 years, replaced lost or broken eyeglasses must be identical to originals | Fee for service | |
| Mississippi | Yes | CN | $3/pair | 1 pair eyeglasses/5 years | Acquisition cost | |
| Missouri | Yes | CN | $.50-$3/item or service, depending on payment | Limited to post-cataract surgery eyeglasses | Fee for service | |
| Montana | Yes | CN & MN | $2/pair | 1 pair eyeglasses/2 years unless post-cataract surgery or minimum diopter correction criteria met | 2 pair eyeglasses rather than bifocals | Products provided by state's volume purchase contractor, dispensing provider paid fee for service |
| Nebraska | Yes | CN & MN | $2/pair | Minimum diopter correction required for initial and replacement eyeglasses, replacements only if eyeglasses lost or unusable, contact lenses for specified medical conditions | Fee for service | |
| Nevada | Yes | CN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met | Acquisition cost with ceilings | ||
| New Hampshire | Yes | CN & MN | 1 pair eyeglasses/year if minimum diopter correction criteria met, limit also applies to replacements and repairs | Fee for service | ||
| New Jersey | Yes | CN & MN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 19-59 | Acquisition cost with ceilings | ||
| New Mexico | Yes | CN | Acquisition cost with ceilings | |||
| New York | Yes | CN & MN | $3/visit | 1 pair eyeglasses/2 years | Special lenses and other specified services | Fee for service |
| North Carolina | Yes | CN & MN | $2/pair and for supplies or repairs costing more than $5 | Minimum diopter correction criteria, repairs costing less than $5 not covered, limited frame selection | Yes | Most products provided by state's volume purchase contractor, dispensing fee is negotiated rate |
| North Dakota | Yes | CN & MN | 1 pair/2 years, broken eyeglasses must be repaired if possible, replacement of hard contact lenses allowed only if beneficiary had them prior to Medicaid eligibility | Fee for service for eyeglass frames, acquisition cost for lenses | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 pair eyeglasses/2 years | Yes | ||
| Ohio | Yes | CN | 1 pair eyeglasses/year for over age 59, 1 pair/2 years for age 21-59 | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | CN & MN | 1 pair eyeglasses/2 years; contact lenses if specified criteria met; multiple pairs, special lenses and low vision aids not covered | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, acquisition cost for other items | |
| Pennsylvania | Yes | CN & MN | MN: limited to services provided in outpatient hospital clinic setting and billed as a clinic service, limited to aphakia and cataract conditions | Fee for service | ||
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN - see state-specific FN | 1 pair eyeglasses/2 years | Negotiated fee for eyeglass frames, industry provided price list for lenses | ||
| South Carolina | Yes | CN | Limited to post-cataract surgery lenses and eyeglasses | Yes | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service | |
| South Dakota | Yes | CN | 1 pair eyeglasses/15 months if minimum diopter correction criteria met, 2 replacement contact lenses/year | Fee for service | ||
| Tennessee | Yes | A & B - See state-specific FN | Limited to 1 pair of post-cataract surgery lenses or eyeglasses | |||
| Texas | Yes | CN & MN | 1 pair eyeglasses/2 years if minimum diopter correction criteria met, interim replacements not covered | Reasonable charge with limits, repairs more than $2 paid cost plus handling fee | ||
| Utah | Yes | A & C - See state specific FN | C - coverage limited to post-cataract surgery contact lenses | Fee for service | ||
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Annual prescription must be written by public health facility physician | Fee for service | ||
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 pair eyeglasses/2 years except 1 pair eyeglasses/year for developmentally disabled | 2 pair eyeglasses rather than bifocals | Fee for service | |
| West Virginia | Yes | CN & MN | 1 pair eyeglasses following cataract surgery | Specified items and services | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3/service, depending on service | 1 pair eyeglasses/year and 1 replacement/year if eyeglasses lost or broken | Items from other than state's contractor | Most products provided by state's volume purchase contractor, dispensing provider paid fee for service, average acquisition cost for other items |
| Wyoming | Yes | CN | Limited to post-cataract surgery lenses | Fee for service |