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TRICARE Reference Room: Eye Examinations (Article 17) |
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It’s important for optometrist, ophthalmologist and primary care manager (PCM) offices to remember the details of TRICARE vision benefits. Here’s a quick refresher:
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Routine Eye Examinations
CPT Codes: 92002, 92004, 92012, 92014, 92015, 99172, 99173
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A routine eye exam is an evaluation of the eyes (including, but not limited to, refractive services) that is not related to a medical or surgical condition or to the medical or surgical treatment of a covered illness or injury. Routine exams are covered annually for active duty service members (ADSMs) and active duty family members (ADFMs) at no cost.
A PCM referral or authorization from Humana Military is not required for TRICARE Prime beneficiaries in most cases unless care is received from a non-network provider. ADSMs must always have a referral.
The frequency of routine eye exams is tracked on a yearly basis. For example, if an ADFM received an exam on April 1, 2005, the next exam can be scheduled on or after April 1, 2006.
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Clinical Preventive Eye Examinations
CPT Codes: 92002, 92004, 92012, 92014, 92015, 99172, 99173
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A clinical preventive eye exam is a comprehensive screening for determination of vision on visual acuity, ocular alignment and red reflux, along with external examination for ocular abnormalities. Preventive eye exams are covered every two years for all TRICARE Prime enrollees at no cost. A PCM referral or authorization from Humana Military is not required for TRICARE Prime beneficiaries in most cases unless care is received from a non-network provider. ADSMs must always have a referral.
The frequency of clinical preventive eye exams is tracked annually by calendar year. If a TRICARE Prime beneficiary received an exam on April 1, 2005, for example, the next exam can be scheduled on or after April 1, 2007.
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Well-Child Vision Screenings
CPT Codes: 92002, 92004, 92012, 92015, 99172, 99173 |
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The well-child benefit is available to all TRICARE beneficiaries from birth to age 6 and includes eye and vision screening by a PCM during a routine examination at birth and at approximately 6 months of age. Comprehensive eye examinations are authorized once every two years between ages 3 and 6. |
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Contacts (Article 18) |
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Last Reviewed: February 13, 2007
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