Medicaid Benefits: Optometrist Services
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 43 No - 2 NR - 6 | 2018 data limited to CN | Yes - 23 | Yes - 27 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes | CN | $1.30 - $3.90 each visit | Limit of one visit every 3 calendar years | - | - |
| Alaska | Yes | CN | $3 | Must be prior authorized | - | - |
| Arizona | Yes | CN | No | No | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | $1 per outpatient visit | 1 refractive exam/2 years, orthoptics not covered | - | - |
| Colorado | Yes | CN | $2 per visit | No | - | - |
| Connecticut | Yes | CN | No | Vision analysis within 42 consecutive days from the date of eye examination. | - | - |
| Delaware | Yes | CN | No | >21 medical necessary diagnostic and treatment for symptomatic individuals, no routine eye care | - | - |
| District of Columbia | Yes | CN | No | Some items require a PA | - | - |
| Florida | Yes | CN | Recipients are responsible for the following copayment, unless the recipient is exempt: $2.00 per practitioner office visit, per day, $3.00 per federally qualified health center visit, per day, $3.00 per rural health clinic visit, per day | Blepharoplasty when the drooping or sagging of the eyelid(s) interferes with the recipient’s vision; Up to four computerized corneal topography per year; Up to four intravitreal implants per year; One initial consultation visit per year; Pathology and laboratory services (the laboratory must hold a Clinical Laboratory Improvement Amendments license); Special ophthalmological services when performed in addition to a general ophthalmological, or evaluation and management visit; Up to 12 temporary lacrimal punctum plugs per year when a more permanent conservative treatment will cause discomfort; Up to two evaluation and management visits per month; Up to two refractions every 365 days; Visual examination services performed when there is a reported vision problem, illness, disease, or injury | - | - |
| Georgia | Yes | CN | $1 copay | No | - | - |
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | 1 refractive exam/2 years. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $2.00 per service date | 1 eye exam every 4 years 1 pair eye glasses every 4 years Contact lenses are covered with prior authorization | - | - |
| Kentucky | Yes | CN | $3 | New patient exam 1 per recipient per provider per 3-year period; 1 per year if established patient | - | - |
| Louisiana | No | - | - | |||
| Maine | Yes | CN | $.50 to $3/day depending on payment amount, up to $30/month | 1 eye exam/3 years unless ICF/IID resident, then 1 eye exam/year | - | - |
| Maryland | Yes | CN | No | No | - | - |
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | $2/visit | No | - | - |
| Minnesota | Yes | CN | $3 copay for non-preventive office visits | No | - | - |
| Mississippi | Yes | CN | $3 per visit | Applies to the 12 physician office visit limit per state fiscal year | - | - |
| Missouri | Yes | CN | $.50 to $3 depending on cost | No | - | - |
| Montana | Yes | CN | Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount | One eye examination for determining refractive state every 2 years | - | - |
| Nebraska | Yes | CN | $2 per office visit | No | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | No | No | - | - |
| New Mexico | Yes | CN | $7 for WDI recipients | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | Limited to services required to treat medical conditions of the eye, refractive exams are not covered. | - | - |
| North Dakota | Yes | CN | $2 per visit | 1 exam every 2 years 1 exam per year for diabetics | - | - |
| 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 | Comprehensive exam every 12 or 24 months depending on individual's age.without PA. | - | - |
| Oklahoma | Yes | CN | $4 per visit | Payment is made for treatment of medical or surgical conditions which affect the eyes. There is NO provision for routine eye exams, examinations for the purpose of prescribing glasses or visual aids, determination of refractive state, treatment of refractive errors, or purchase of lenses, frames, or visual aids. Services are subject to the existing visit limitation of 4 visits per month. | - | - |
| Oregon | Yes | CN | No | Limits to non-pregnant adults age 21 and over: Routine vision services for the sole purpose of eyeglasses, are not covered. Coverage does include emergency eye exams and treatment and Non-emergency visual services with specific medical diagnoses. | - | - |
| Pennsylvania | Yes | CN | Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80 | 2 visits (exams) per calendar year | - | - |
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | $2/visit | Refractive exams only, once every 12 months. | - | - |
| Tennessee | Yes | CN | No | Limited to medical eye care, refractive exams not covered. | - | - |
| Texas | Yes | CN | No | Some require prior authorization and others diagnosis restricted | - | - |
| Utah | Yes | CN | $4 per visit | No | - | - |
| Vermont | Yes | CN | No | 1 refractive exam including visual analysis every two years; special lenses and visual aids when specified criteria met and require prior authorization | - | - |
| Virginia | No | - | - | |||
| Washington | Yes | CN | No | Some may require Prior authorization | - | - |
| West Virginia | Yes | CN | No | Eye examinations are limited to comprehensive exam/evaluation for medical necessity only. Visual examinations to determine the need for eyeglasses are covered for children only. Additionally, diagnostic evaluations and examinations may be reimbursed when documentation in the medical record justifies the medical need for more frequent exams. | - | - |
| Wisconsin | Yes | CN | $0.50 - $3, depending on the service. | A small number of services require prior approval. | - | - |
| Wyoming | Yes | CN | No | Services limited to treatment of eye disease or eye injury only. No glasses/contacts. | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 29 No - 27 | ||||
| Alabama | Yes | CN | $1/visit | 1 refractive exam/3 years | Orthoptics and orthoptic training | Fee for service |
| Alaska | Yes | CN | 1 refractive exam/year | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | 1 refractive exam/2 years | |||
| Arizona | Yes | CN & MN | Limited to emergency eye care and treatment of medical conditions, vision exam limited to post-cataract surgery services | Fee for service | ||
| Arkansas | Yes | CN & MN | 1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | 1 refractive exam/2 years, orthoptics not covered | Fee for service | |
| Colorado | Yes | CN | $3/visit | Limited to services to diagnose or treat injury or disease of eye or following eye surgery | Specified services | Fee for service |
| Connecticut | Yes | CN & MN | 1 refractive exam/year | Visual training | Fee for service with some services paid 90% of physician fee | |
| Delaware | Yes | CN | Routine vision care not covered, benefit limited to diagnosis and treatment of medical eye problems | Fee for service | ||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $2/day | Eye exams limited to determining presence of disease or reported vision problem | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 depending on payment rate | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care, refractive exams covered for nursing facility residents with specific physician order | Fee for service at 84.645% of CMS RBRVS rates for 2000 | |
| Guam | Yes | CN | Yes | Fee for service using Medicare fee schedule | ||
| Hawaii | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Idaho | Yes | CN | $3.65/visit up to 5% of income/year across all services | Limited to treatment necessitated by specified chronic systemic conditions | Fee for service | |
| Illinois | Yes | CN & MN | $3.65/visit | 1 refractive exam/year | Specified items, including visual aids | Fee for service or certified cost |
| Indiana | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 routine exam/year, 1 refractive exam/year, visual aids covered when visual acuity criteria met and visual therapy limited to 90 days | Visual therapy, low vision aids in specified situations | Fee for service |
| Kansas | Yes | CN & MN | $2/date of service | 1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | |
| Louisiana | Yes | CN & MN | Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Limited to dispensing and fitting eyeglasses and 1 routine eye exam/3 years, 1 routine eye exam/year for ICF/MR residents | Specified services | Fee for service |
| Maryland | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Massachusetts | Yes | CN & MN | 1 refractive exam/2 years unless specific diagnostic criteria met | Specified services/items including vision training | Fee for service | |
| Michigan | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 1 refractive exam/5 years included in physician visit limitations | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | 1 vision exam/year with or without refraction except adults who are not pregnant, blind or residing in nursing facilities are limited to 1 exam/2 years | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/visit | A - 1 refractive exam/2 years, additional exams allowed for cataract care; B - Limited to exams essential for employment and for services necessary to diagnose or treat injury or disease of eye | Contact lenses and fittings | Fee for service |
| Nebraska | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Nevada | Yes | CN | 1 refractive exam/year | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 refractive exam/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Visual aids covered when visual acuity criteria met | Visual testing and training | Fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | 1 refractive exam/3 years; A - benefit limited to post-cataract surgery and related services | Fee for service | |
| New York | Yes | CN & MN | 1 refractive exam/2 years, visual aids covered when visual acuity criteria met | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/visit | Limited to services required to treat medical conditions of the eye, refractive exams are not covered | Fee for service | |
| North Dakota | Yes | CN & MN | $2/visit | 1 refractive exam/2 years, 1 eye exam for diabetics/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | $2/refractive exam visit | 1 refractive exam/2 years for age 21-59, 1 exam/year for over age 59 | Fee for service | |
| Oklahoma | Yes | CN | $3/visit | 4 ambulatory visits/month included in physician limit, services limited to medical care only | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Adult coverage limited to pregnant women and specified medical conditions, 1 refractive exam/2 years | Items not from state's contractor | Hardware provided by state's contractor, flat fee paid for dispensing |
| Pennsylvania | Yes | CN & MN | $.65-$3.80/service, depending on payment rate | 2 vision exams/year, | Fee for service | |
| Puerto Rico | Yes | CN & MN | Limited to exams and evaluations | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | Yes | See state-specific FN | 1 refractive exam/2 years | Fee for service | ||
| South Carolina | Yes | CN | Limited to treatment of a visual system disorder | Fee for service | ||
| South Dakota | Yes | CN | $2/visit | Refractive exams only | Fee for service | |
| Tennessee | Yes | A, B & C - See state-specific FN | Limited to medical eye care, refractive exams not covered | See state-specific FN | ||
| Texas | Yes | CN & MN | 1 refractive exam/year unless significant vision changes occur in the interim | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | B - balance of exam cost over $30, C - $5/visit | 1 refractive exam/year, C - low vision therapy not covered | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 comprehensive exam/2 years | Fee for service, using Medicare Relative Value Units and a state conversion factor | ||
| U.S. Virgin Islands | Yes | CN | Limited to dispensing and fitting eyeglasses | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit | 1 eye exam and 1 refractive exam/2 years unless early testing medically indicated | Fee for service | |
| Washington | Yes | CN & MN | 1 refractive exam/2 years, orthoptic therapy not covered | Fee for service | ||
| West Virginia | Yes | A, B & C | 1 refractive exam/3 years | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | Specified services | Fee for service | |
| Wyoming | Yes | CN | $2.45/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 28 No - 28 | ||||
| Alabama | Yes | CN | $1/visit | 1 refractive exam/2 years | Orthoptics and orthoptic training | Fee for service |
| Alaska | Yes | CN | 1 refractive exam/year | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to emergency eye care and treatment of medical conditions, vision exam limited to post-cataract surgery services | Fee for service | ||
| Arkansas | Yes | CN & MN | 1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | 1 refractive exam/2 years, orthoptics not covered | Fee for service | |
| Colorado | Yes | CN | $3/visit | Limited to services to diagnose or treat injury or disease of eye or following eye surgery | Specified services | Fee for service |
| Connecticut | Yes | CN & MN | 1 refractive exam/year | Visual training | Fee for service with some services paid 90% of physician fee | |
| Delaware | Yes | CN | Routine vision care not covered, benefit limited to aphakic or bandage lenses following cataract surgery | Fee for service | ||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $2/day | Eye exams limited to determining presence of disease or reported vision problem | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care, refractive exams covered for nursing facility residents with specific physician order | Fee for service at 84.645% of CMS RBRVS rates for 2000 | |
| Guam | Yes | CN | Yes | Fee for service | ||
| Hawaii | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Idaho | Yes | CN | 1 refractive exam/year | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | 1 refractive exam/year | Specified items, including visual aids | Fee for service or certified cost |
| Indiana | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 refractive exam/year, visual aids covered when visual acuity criteria met and visual therapy limited to 90 days | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | |
| Louisiana | Yes | CN & MN | Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Limited to dispensing and fitting eyeglasses and 1 routine eye exam/2 years, 1 routine eye exam/year for ICF/MR residents | Specified services | Fee for service |
| Maryland | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Massachusetts | Yes | CN & MN | 1 refractive exam/2 years unless specific diagnostic criteria met | Specified services/items including vision training | Fee for service | |
| Michigan | Yes | CN & MN | $2/visit | Routine vision care not covered, adult benefit limited to low-vision services, qualifying diagnosis must be present | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | B - $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 1 refractive exam/5 years included in physician visit limitations | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | 1 vision exam/year with or without refraction except adults who are not pregnant, blind or residing in nursing facilities are limited to 1 exam/2 years | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/visit | A - 1 refractive exam/2 years, additional exams allowed for cataract care B - Limited to exams essential for employment | Contact lenses and fittings | Fee for service |
| Nebraska | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Nevada | Yes | CN | 1 refractive exam/year | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 refractive exam/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Visual aids covered when visual acuity criteria met | Visual testing and training | Fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | 1 refractive exam/3 years; A - benefit limited to post-cataract surgery and related services | Fee for service | |
| New York | Yes | CN & MN | 1 refractive exam/2 years, visual aids covered when visual acuity criteria met | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/visit | 8 visits/year included in limits with other specified practitioners - limits set annually by the legislature | Visual aids | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | $2/refractive exam visit | 1 refractive exam/2 years for over age 20 and under 60, 1 exam/year for age 60 and older | Fee for service | |
| Oklahoma | Yes | CN | $3/visit | 4 ambulatory visits/month included in physician limit, services limited to medical care only | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Adult coverage limited to pregnant women and specified medical conditions, 1 refractive exam/2 years | Items not from state's contractor | Hardware provided by state's contractor, flat fee paid for dispensing |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | 2 vision exams/year, | Fee for service | |
| Puerto Rico | Yes | CN & MN | Limited to exams and evaluations | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | Yes | See state-specific FN | 1 refractive exam/2 years | Fee for service | ||
| South Carolina | Yes | CN | 1 refractive exam/year | Fee for service | ||
| South Dakota | Yes | CN | $3/visit | Refractive exams only | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to medical eye care, refractive exams not covered | See state-specific FN | ||
| Texas | Yes | CN & MN | 1 refractive exam/year unless significant vision changes occur in the interim | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | B - balance of exam cost over $30, C - $5/visit | A - adult coverage limited to pregnant women, B & C - 1 refractive exam/year, low vision therapy not covered | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 comprehensive exam/2 years | Fee for service, using Medicare Relative Value Units and a state conversion factor | ||
| U.S. Virgin Islands | Yes | CN | Limited to dispensing and fitting eyeglasses | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit | Refractive exams only | Fee for service | |
| Washington | Yes | CN & MN | 1 refractive exam/2 years, orthoptic therapy not covered | Fee for service | ||
| West Virginia | Yes | A, B & C | 1 refractive exam/3 years | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | Specified services | Fee for service | |
| Wyoming | Yes | CN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 28 No - 28 | ||||
| Alabama | Yes | CN | $1/visit | 1 refractive exam/2 years | Orthoptics and orthoptic training | Fee for service |
| Alaska | Yes | CN | 1 refractive exam/year | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to emergency eye care and treatment of medical conditions, vision exam limited to post-cataract surgery services | Fee for service | ||
| Arkansas | Yes | CN & MN | 1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | 1 refractive exam/2 years, orthoptics not covered | Fee for service | |
| Colorado | Yes | CN | $2/visit | Yes | Fee for service | |
| Connecticut | Yes | CN & MN | 1 refractive exam/year | Visual training | Fee for service with some services paid 90% of physician fee | |
| Delaware | Yes | CN | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | ||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $2/day | Eye exams limited to determining presence of disease or reported vision problem | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care, refractive exams covered for nursing facility residents with specific physician order | Fee for service at 84.645% of CMS RBRVS rates for 2000 | |
| Guam | Yes | CN | Yes | Fee for service | ||
| Hawaii | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Idaho | Yes | CN | 1 refractive exam/year | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | 1 refractive exam/year | Specified items, including visual aids | Fee for service or certified cost |
| Indiana | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 refractive exam/year, visual aids covered when visual acuity criteria met and visual therapy limited to 90 days | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | |
| Louisiana | Yes | CN & MN | Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to dispensing and fitting eyeglasses and 1 routine eye exam/2 years, 1 routine eye exam/year for ICF/MR residents | Specified services | Fee for service |
| Maryland | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Massachusetts | Yes | CN & MN | 1 refractive exam/2 years unless specific diagnostic criteria met | Specified services/items including vision training | Fee for service | |
| Michigan | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 1 refractive exam/5 years included in physician visit limitations | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | 1 vision exam/year with or without refraction except adults who are not pregnant, blind or residing in nursing facilities are limited to 1 exam/2 years | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/visit | A - 1 refractive exam/2 years, additional exams allowed for cataract care B - Limited to exams essential for employment | Visual training | Fee for service |
| Nebraska | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Nevada | Yes | CN | Limited to treatment of medical conditions, including glaucoma and cataracts | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 refractive exam/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Visual aids covered when visual acuity criteria met | Visual testing and training | Fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | 1 refractive exam/2 years | Fee for service | |
| New York | Yes | CN & MN | 1 refractive exam/2 years, visual aids covered when visual acuity criteria met | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/visit | 8 visits/year included in limits with other specified practitioners - limits set annually by the legislature | Visual aids | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | 1 refractive exam/3 years | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | $2/refractive exam visit | 1 refractive exam/2 years for over age 20 and under 60, 1 exam/year for age 60 and older | Fee for service | |
| Oklahoma | Yes | CN | $1/service | 4 ambulatory visits/month included in physician limit, services limited to medical care only | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | 1 refractive exam/2 years | Fee for service | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | 2 vision exams/year, | Fee for service | |
| Puerto Rico | Yes | CN & MN | Limited to exams and evaluations | Fee for service for contracted staff, cost based payment for public health staff | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | 1 refractive exam/2 years | Fee for service | ||
| South Carolina | Yes | CN | 1 refractive exam/year | Fee for service | ||
| South Dakota | Yes | CN | $3/visit | Refractive exams only | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to medical eye care, refractive exams not covered | |||
| Texas | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | B - balance of exam cost over $30, C - $5/visit | A - adult coverage limited to pregnant women, B & C - 1 refractive exam/year, low vision therapy not covered | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | A - 1 comprehensive exam/2 years, B - 1 comprehensive exam/2 years and only covered under PC Plus | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Limited to dispensing and fitting eyeglasses | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit | Refractive exams only | Fee for service | |
| Washington | Yes | CN & MN | 1 refractive exam/2 years, orthoptic therapy not covered | Fee for service | ||
| West Virginia | Yes | A, B & C | 1 refractive exam/3 years | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | Specified services | Fee for service | |
| Wyoming | Yes | CN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 29 No - 27 | ||||
| Alabama | Yes | CN | $1/visit | 1 refractive exam/2 years | Orthoptics and orthoptic training | Fee for service |
| Alaska | Yes | CN | 1 refractive exam/year | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to emergency eye care and treatment of medical conditions, vision exam limited to post-cataract surgery services | Fee for service | ||
| Arkansas | Yes | CN & MN | 1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | 1 refractive exam/2 years, orthoptics not covered | Fee for service | |
| Colorado | Yes | CN | $2/visit | Yes | Fee for service | |
| Connecticut | Yes | CN & MN | 1 refractive exam/year | Visual training | Fee for service with some services paid 90% of physician fee | |
| Delaware | Yes | CN | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | ||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $2/day | Eye exams limited to determining presence of disease or reported vision problem | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care, refractive exams covered for nursing facility residents with specific physician order | Fee for service | |
| Guam | Yes | CN | Yes | Fee for service | ||
| Hawaii | Yes | CN & MN | Orthoptics and orthoptic training not covered | Specified items, including visual aids costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 1 refractive exam/year, certified optometrists may diagnose and treat medical eye problems | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | 1 refractive exam/year | Specified items, including visual aids | Fee for service or certified cost |
| Indiana | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 refractive exam/year, visual aids covered when visual acuity criteria met and visual therapy limited to 90 days | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | |
| Louisiana | Yes | CN & MN | Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to dispensing and fitting eyeglasses and 1 routine eye exam/2 years, 1 routine eye exam/year for ICF/MR residents | Specified services | Fee for service |
| Maryland | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Massachusetts | Yes | CN & MN | 1 refractive exam/2 years unless specific diagnostic criteria met | Specified services/items including vision training | Fee for service | |
| Michigan | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 1 refractive exam/5 years included in physician visit limitations | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | 1 vision exam/year with or without refraction except adults who are not pregnant, blind or residing in nursing facilities are limited to 1 exam/2 years | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/visit | A - 1 refractive exam/2 years, additional exams allowed for cataract care B - Limited to exams essential for employment | Visual training | Fee for service |
| Nebraska | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Nevada | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 refractive exam/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Visual aids covered when visual acuity criteria met | Visual testing and training | Fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | 1 refractive exam/2 years | Fee for service | |
| New York | Yes | CN & MN | 1 refractive exam/2 years, visual aids covered when visual acuity criteria met | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/visit | 1 refractive exam/2 years | Visual aids | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | 1 refractive exam/3 years | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | $2/refractive exam visit | 1 refractive exam/2 years for over age 20 and under 60, 1 exam/year for age 60 and older | Fee for service | |
| Oklahoma | Yes | CN | $1/service | Visits included in physician 4 visit/month limit | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | 1 refractive exam/2 years | Fee for service | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment | 2 vision exams/year | Fee for service | |
| Puerto Rico | Yes | CN & MN | Limited to exams and evaluations | Fee for service for contracted staff, cost based payment for public health staff | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | 1 refractive exam/2 years | Fee for service | ||
| South Carolina | Yes | CN | $2/visit | 1 refractive exam/year | Fee for service | |
| South Dakota | Yes | CN | $3/visit | Refractive exams only | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to medical eye care, refractive exams not covered | |||
| Texas | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | B - balance of exam cost over $30, C - $5/visit | A - adult coverage limited to pregnant women, B & C - 1 refractive exam/year, low vision therapy not covered | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | A - 1 refractive exam/2 years, B - 1 refractive exam/2 years and only covered under PC Plus | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Limited to dispensing and fitting eyeglasses | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit | Refractive exams only | Fee for service | |
| Washington | Yes | CN & MN | 1 refractive exam/2 years, orthoptic therapy not covered | Fee for service | ||
| West Virginia | Yes | CN & MN | 1 refractive exam/3 years | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | Specified services | Fee for service | |
| Wyoming | Yes | CN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 27 No - 29 | ||||
| Alabama | Yes | CN | $1/visit | 1 refractive exam/2 years | Orthoptics and orthoptic training | Fee for service |
| Alaska | Yes | CN | 1 refractive exam/year | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery services | Fee for service | ||
| Arkansas | Yes | CN & MN | 1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | 1 refractive exam/2 years, orthoptics not covered | Fee for service | |
| Colorado | Yes | CN | $2/visit | Yes | Fee for service | |
| Connecticut | Yes | CN & MN | Visual training | Fee for service | ||
| Delaware | Yes | CN | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | ||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $2/day | Eye exams limited to determining presence of disease | Fee for service | |
| Georgia | Yes | CN & MN | $1/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care, refractive exams covered only for nursing facility residents | Fee for service | |
| Guam | Yes | CN | Yes | Fee for service | ||
| Hawaii | Yes | CN & MN | Orthoptics and orthoptic training not covered | Specified items, including visual aids costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 1 refractive exam/year, certified optometrists may diagnose and treat medical eye problems | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | 1 refractive exam/year | Specified items, including visual aids | Fee for service or certified cost |
| Indiana | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| Iowa | Yes | CN & MN | $2/day | 1 refractive exam/year, visual aids covered when visual acuity criteria met and visual therapy limited to 90 days | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered | Fee for service | |
| Kentucky | Yes | CN & MN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | |
| Louisiana | Yes | CN & MN | Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to dispensing and fitting eyeglasses | Fee for service | |
| Maryland | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Massachusetts | Yes | CN & MN | 1 refractive exam/2 years unless specific diagnostic criteria met | Specified items, including visual aids costing more than $50 | Fee for service | |
| Michigan | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Fee for service | ||
| Missouri | Yes | CN | $.50-$3/service, depending on payment | 1 vision exam/year with or without refraction | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $2/visit | A - 1 refractive exam/2 years, additional exams allowed for cataract care B - Limited to exams essential for employment | Visual training | Fee for service |
| Nebraska | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Nevada | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 refractive exam/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Visual aids covered when visual acuity criteria met | Visual testing and training | Fee for service | |
| New Mexico | Yes | CN | B - $7/visit - see state-specific FN | 1 refractive exam/2 years | Fee for service | |
| New York | Yes | CN & MN | 1 refractive exam/2 years, visual aids covered when visual acuity criteria met | Fee for service | ||
| North Carolina | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Visual aids | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | 1 refractive exam/3 years | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | 1 refractive exam/2 years for over age 20 and under 60, 1 exam/year for age 60 and older | Fee for service | ||
| Oklahoma | Yes | CN | $1/service | Visits included in physician 4 visit/month limit | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | 1 refractive exam/2 years | Fee for service | |
| Pennsylvania | Yes | CN & MN | 2 vision exams/year | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN & MN - see state-specific FN | 1 refractive exam/2 years | Fee for service | ||
| South Carolina | Yes | CN | $1/visit | Refractive exams only | Fee for service | |
| South Dakota | Yes | CN | $1/service | Refractive exams only | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to medical eye care, refractive exams not covered | |||
| Texas | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | B - balance of exam cost over $30, C - $5/visit | A - adult coverage limited to pregnant women, B & C - 1 refractive exam/year, low vision therapy not covered | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 refractive exam/2 years | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Limited to dispensing and fitting eyeglasses | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit | Refractive exams only | Fee for service | |
| Washington | Yes | CN & MN | 1 refractive exam/2 years, orthoptic therapy not covered | Fee for service | ||
| West Virginia | Yes | CN & MN | 1 refractive exam/3 years | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | Specified services | Fee for service | |
| Wyoming | Yes | CN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 25 No - 31 | ||||
| Alabama | Yes | CN | $1/visit | 1 vision exam/year with or without refraction | Orthoptics and orthoptic training | Fee for service |
| Alaska | Yes | CN | 1 refractive exam/year | Fee for service | ||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to post-cataract surgery services | Fee for service | ||
| Arkansas | Yes | CN & MN | 1 refractive exam/2 years, 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | 1 refractive exam/2 years, orthoptics not covered | Fee for service | |
| Colorado | Yes | CN | $2/visit | Yes | Fee for service | |
| Connecticut | Yes | CN & MN | 1 refractive exam/year | Visual training | Fee for service | |
| Delaware | Yes | CN | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | ||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $2/day | Eye exams limited to determining presence of disease | Fee for service | |
| Georgia | Yes | CN & MN | $1/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care, refractive exams covered only for nursing facility residents | Fee for service | |
| Guam | Yes | CN | Yes | Fee for service | ||
| Hawaii | Yes | CN & MN | Orthoptics and orthoptic training not covered | Specified items, including visual aids costing more than $50 | Fee for service | |
| Idaho | Yes | CN | 1 refractive exam/year, certified optometrists may diagnose and treat medical eye problems | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | 1 refractive exam/year | Specified items, including visual aids | Fee for service or certified cost |
| Indiana | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| Iowa | Yes | CN & MN | $2/visit | 1 refractive exam/year, visual aids covered when visual acuity criteria met and visual therapy limited to 90 days | Fee for service | |
| Kansas | Yes | CN & MN | $2/date of service | 1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered | Fee for service | |
| Kentucky | Yes | CN & MN | Limited to diagnosis and treatment of medical eye problems as permitted by law | Fee for service | ||
| Louisiana | Yes | CN & MN | Limited to diagnosis and treatment of medical eye problems as permitted by law,12 visits/year included in physician visit limit | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to dispensing and fitting eyeglasses | Fee for service | |
| Maryland | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Massachusetts | Yes | CN & MN | 1 refractive exam/2 years unless specific diagnostic criteria met | Specified items, including visual aids costing more than $50 | Fee for service | |
| Michigan | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | A - $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Fee for service | ||
| Missouri | Yes | CN | $.50-$3/service, depending on payment | 1 refractive exam/year | Fee for service | |
| Montana | Yes | CN & MN | $2/visit | 1 refractive exam/2 years, additional exams allowed for cataract care | Visual training | Fee for service |
| Nebraska | Yes | CN & MN | $2/visit | 1 refractive exam/2 years | Fee for service | |
| Nevada | Yes | CN | 1 refractive exam/2 years | Fee for service | ||
| New Hampshire | Yes | CN & MN | 1 refractive exam/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Visual aids covered when visual acuity criteria met | Visual testing and training | Fee for service | |
| New Mexico | Yes | CN | B - $5/visit - see state-specific FN | Fee for service | ||
| New York | Yes | CN & MN | 1 refractive exam/2 years, visual aids covered when visual acuity criteria met | Fee for service | ||
| North Carolina | Yes | CN & MN | $2/visit | 1 refractive exam/2 years for over age 24 and 1 exam/year for younger | Visual aids | Fee for service |
| North Dakota | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | 1 refractive exam/2 years for over age 20 and under 60, 1 exam/year for age 60 and older | Fee for service | ||
| Oklahoma | Yes | CN & MN | $1/service | Visits included in physician 2 visit/month limit | Fee for service | |
| Oregon | Yes | CN & MN | $3/visit | 1 refractive exam/2 years | Fee for service | |
| Pennsylvania | Yes | CN & MN | 2 vision exams/year | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN & MN - see state-specific FN | 1 refractive exam/2 years | Fee for service | ||
| South Carolina | Yes | CN | Refractive exams only | Fee for service | ||
| South Dakota | Yes | CN | $1/service | Refractive exams only | Fee for service | |
| Tennessee | Yes | A & B - See state-specific FN | Limited to medical eye care, refractive exams not covered | |||
| Texas | Yes | CN & MN | 1 refractive exam/2 years | Fee for service | ||
| Utah | Yes | A, B & C - See state specific FN | B & C - balance of exam cost over $30 | B & C - 1 refractive exam/year, low vision therapy not covered | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | B - $7/visit | 1 refractive exam/2 years | Fee for service | |
| U.S. Virgin Islands | Yes | CN | Limited to dispensing and fitting eyeglasses | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit | Refractive exams only | Fee for service | |
| Washington | Yes | CN & MN | 1 refractive exam/2 years, orthoptic therapy not covered | Fee for service | ||
| West Virginia | Yes | CN & MN | 1 refractive exam/3 years | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service | Specified services | Fee for service | |
| Wyoming | Yes | CN | $2/visit | Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care | Fee for service |