VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Details pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

VSP’s Medicaid Plan is based on contracts with health care organizations (clients) to provide the vision care portion of the state’s Medicaid program.

Clients are required to provide the minimum benefits specified by your state’s Medicaid program, but may also offer enhanced benefits.

Please refer to Client Detail pages and/or Medicaid Fee Schedules for details about administration of basic state benefits. For state information, refer to the State Medicaid Manual.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patents experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient medical record.

All providers who serve Medicaid patients are required to complete and attest to having completed cultural competency training annually. Network doctors who own their practice are required to attest that they and their staff, including all employee doctors, completed the training. VSP makes this training available on VSPOnline and sends via email annually. You may take it at any time at least once per calendar year. The training modules include:

• Cultural Competency
• Better Communication, Better Care: Provider Tools to Care for Diverse Populations
• Seniors and Persons with Disabilities
• Patients’ Rights and Responsibilities

If you completed cultural competence training from another source, you may attest to that in lieu of taking VSP-provided training. The attestation is available on VSPOnline in the Cultural Competency training section or can be accessed from the link in the annual email reminder.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patents experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient medical record.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patients experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient's medical record.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

•  Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

VSP requires network doctors to use an appointment scheduling process and system that allows appointments to be scheduled according to patients’ stated eye care needs within the timeliness standards established for VSP members. The intent is to ensure that patients are handled consistently and scheduled for appointments in a manner that recognizes the urgency of their eye care needs.

• Patents experiencing an eye care emergency should be seen immediately or referred to an appropriate alternative medical facility.
• Make every effort to see the patient at their scheduled appointment time. Patient wait time should not exceed 30 minutes.
• The site must have (or arrange for) a telephone triage, voicemail system, and/or answering service to provide routine, after-hours, and urgent/emergency eye care instructions, whenever office staff is unavailable to answer phone calls. Patients should receive a return call from this system for follow-up within a reasonable timeframe.
• Ensure a process is in place to follow up on missed and canceled appointments. Missed and/or canceled appointments and contact attempts must be documented in the patient medical record.

When you contact VSP for an authorization, please provide the following information:

• Last four-digits of the member’s Social Security Number and date of birth or the entire client-assigned ID number
• Member’s Medicaid number if different from Social Security Number
• Patient’s date of birth
• Patient’s HMO name

There are several ways to obtain an authorization:

VSP’s Electronic Claim Submission System—Enter member’s Social Security Number or client-assigned ID number using eyefinity’s website and select “Check Patient Eligibility” to access eligible plans. You may wish to print the plan information to discuss plan coverages with your patients.

Customer Service—Call VSP at 800.615.1883. You may select “1” to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient’s current eligibility, provide plan information, and issue an authorization.

When you contact VSP for an authorization, please provide the following information: 

• Last four-digits of the member's Social Security Number and date of birth or the entire client-assigned ID number 
• Member's Medicaid number if different from Social Security Number
• Patient's date of birth 
• Patient's HMO name 

There are several ways to obtain an authorization: 

VSP's Electronic Claim Submission System - Enter member's Social Security Number or client-assigned ID number using eyefinity's website and select "Check Patient Eligibility" to access eligible plans. You may wish to print the plan information to discuss plan coverage with your patients. 

Customer Service - Call VSP at 800.615.1883. You may select "1" to contact our automated Interactive Voice Response (IVR) system, or you may speak with a Customer Service Representative who will verify the patient's current eligibility, provide plan information, and issue an authorization. 

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

Note: 

When the member’s eligibility has been verified, VSP will provide an authorization number that is effective through the last day of the current month.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or another VSP plan, you must bill that carrier or the other VSP plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient’s responsibility for exam and refraction separately.

If the Medicaid patient has vision care coverage through any carrier other than VSP or any other VSP plan, you must bill that carrier or the other VPS plan first. The VSP Medicaid Plan should be billed as secondary, where appropriate. For electronic claim submission, be sure to provide the patient's responsibility for exam and refraction separately. 

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.
In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Routine eye exam coverage and timeframes are established by State regulations.

In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule.

For Telemedicine information refer to: Telemedicine.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Routine eye exam coverage and timeframes are established by State regulations. In addition to coverage for routine vision care services, Medicaid members are typically covered for services under Essential Medical Eye Care or Integrated Primary EyeCare Program. Any exceptions to this coverage are described in the Client Detail pages and/or the Fee Schedule. For Telemedicine information refer to: Telemedicine.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

Follow all referral protocols set forth by your patient's health plan for any services beyond the scope of the patient's VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions. 

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement

Reimbursement for CPT Category II Codes 

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 4/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursment the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Patients with Diabetes WITH Evidence of Retinopathy 

Patients with Diabetes WITHOUT Evidence of Retinopathy 

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

Follow all referral protocols set forth by your patient’s health plan for any services beyond the scope of the patient’s VSP plan. Typically, an HMO requires that patient referrals be coordinated by the primary care physician (PCP). However, a PPO usually allows patients to receive care from any medical provider without a PCP referral. Check Client Detail pages for any specific instructions or exceptions.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare's most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement. 

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.

Measurement Definitions: 

Patients ages 18-75 with diabetes (Type 1 and Type 2) who received screening or monitoring for diabetic retinal eye disease: 

• Retinal or dilated eye exam by an eye care professional in the measurement year or, 
• A negative retinal or dilated eye exam by an eye care professional in the year prior to measurement year. 
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement.

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes 

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 10/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement, the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VSP patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes 

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VSP patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VSP patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes 

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VSP patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is one of healthcare’s most widely used performance improvement tools. The National Committee for Quality Assurance (NCQA) collects HEDIS data from health plans and other healthcare organizations to create annual health outcome surveys. Health plans use HEDIS data to measure performance and identify opportunities for improvement.

HEDIS includes more than 90 measures across multiple domains of care. These measures relate to public health issues, including (and not limited to) asthma medication use, blood pressure control, cancer screening, diabetes care, heart disease, and smoking and tobacco use cessation.

Eye Exam for Patients With Diabetes (EED) – Effectiveness of Care HEDIS Measure

Eye Exam for Patients With Diabetes (EED) is a specific HEDIS measure that requires health plans offering commercial, Medicaid, and Medicare plans to report the percentage of members with diabetes who had a dilated or retinal eye exam.
 
Measurement Definition:
Patients ages 18–75 with diabetes (Type 1 or Type 2) who received screening or monitoring for diabetic retinal eye disease:

• Retinal or dilated eye exam by an eye care professional in the measurement year or,
• A negative retinal or dilated eye exam by an eye care professional in the year prior to the measurement year.
• A slit-lamp examination must have documentation of dilation or evidence that the retina was examined to be considered compliant. Examination of macula, vessels, and periphery without dilation meets the criteria for a “retinal exam.”
• Note: Fundus photography with interpretation and report and certain types of retinal imaging (CPT^® codes 92227, 92228, 92250, 92260, and 92314) covered by Essential Medical Eye Care may also meet the performance measurement

Reimbursement for CPT Category II Codes 

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VSP patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VPS patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VSP patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Reimbursement for CPT Category II Codes 

CPT Category II codes are informational codes that facilitate data collection regarding the quality of care for services (e.g., retinal or dilated eye exams) that support HEDIS measures. CPT Category II codes are not a substitute for Category I codes.

Effective for claims with a date of service on or after 8/1/2025, receive reimbursement for including the appropriate CPT Category II code when submitting dilated or retinal eye exam claims for VSP patients with diabetes. To receive the reimbursement the claim must: 

• Indicate the patient has diabetes or diabetic retinopathy by checking the Patient Condition box in eClaim or including a diagnosis code
• Include one of the following exam codes 92002, 92004, 92012, 92014, S0620, or S0621
• Include one of the CPT Category II codes below with a billed amount of $5.00 

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Patients with Diabetes WITH Evidence of Retinopathy

Patients with Diabetes WITHOUT Evidence of Retinopathy

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Current Procedural Terminology (CPT) Category II codes developed by the American Medical Association (AMA)

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note:

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Note:

Please refer to the Patient Record Report, authorization, or Client Detail pages to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

For more information, please refer to your Client Detail pages and/or Fee Schedule.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

For more information, please refer to your Client Detail pages and/or Fee Schedule.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

Lenses are available to the patient based on state regulations.

Covered basic lenses are established by state regulations.

Progressive lens: If not a covered benefit and the member chooses to enhance their lens to progressive, charge the patient the difference between the flat top 28 bifocal lens and progressive. 

For more information, please refer to your Client Detail pages and/or Fee Schedule.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, a dispensing fee may only be billed with a complete set of eyeglasses (frame and lenses). Please refer to your state provider manual for eligibility and state-specific guidelines. 

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill repairs to eyeglasses using CPT code 92370 (repair and refitting of spectacles) or CPT code 92371 (repair of spectacle prosthesis for aphakia).

Do not bill a dispensing code for repairs.

Repair and refitting codes cannot be billed with material HCPCS codes (e.g., V2020) on the same date of service.

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses. 

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).  

Please refer to your state provider manual for eligibility and state-specific guidelines. 

If a covered benefit, bill replacement frame and lenses using the appropriate frame or lens HCPCS code. Do not bill a dispensing code for replacement of just the frame or lenses.

A dispensing fee may only be billed, if you are replacing a complete set of eyeglasses (frame and lenses).

Please refer to your state provider manual for eligibility and state-specific guidelines.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

Frame coverage is based on state regulations, and providers must offer a wide selection of frames that are fully covered under the Medicaid reimbursement schedule. This selection should reflect a variety of styles, sizes, and materials to accommodate the diverse needs and preferences of patients. For further information refer to your Client Detail pages and/or Fee Schedule.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

If a covered benefit, refer to Client Detail pages as specific criteria applies.

See Services Subject To Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

See Services Subject to Review/Audit for information regarding material record keeping requirements.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the California Medi-Cal Client Details page.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

You may use any lab of your choice on a private invoice basis or fabricate your own materials. Exceptions are noted in the Client Detail pages.

Contract labs that have agreed to provide lenses at a reduced price for VSP are identified in the National Contract Lab List in your VSP Provider Reference Manual. When using a contract lab on this list, please write “VSP Medicaid” and the authorization number on the private invoice to ensure reduced VSP Medicaid materials prices.

To identify a lab that has agreed to charge the fixed Medicaid lab fees, look for the initials N to the left of the lab numbers on the National Contract Lab List.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Bill all allowable items not listed below at your private add-on prices.

Note: 

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees. Exceptions are noted in the California Medi-Cal Client Details page.

Note:

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note:

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note:

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note:

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note:

The lab price schedule below is valid for Medicaid Plan prescriptions only. Please refer to the patient’s authorization and the Medicaid Fee Schedule to determine if any exceptions are covered by your state Medicaid Plan and/or by the client.

Note:

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note:

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses includes:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Note: 

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Note:

Laboratories will charge your office on a private invoice basis. All items not listed are billed at the laboratory’s private add-on prices. Doctor redos are billed by the laboratory at 50% of the scheduled fees.

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

Base lenses include:

• Rxs up to and including 7.00 sphere and 4.00 cylinder
• Plastic or glass lenses (including hardening)
• Zyl, metal, or carbon mounting
• Bifocal or trifocal Segment widths of 25 and 28
• All higher adds
• All base curves
• Press-on prism
• Eye size up to and including 55mm
• Shipping and handling charges to the office

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500  form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the  CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

This material is confidential, intended for the use by VSP doctors only. The contents may not be shared with any unauthorized person. This manual is the property of VSP.

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

The filing limit for submitting claims in most states is 180 days from the date of service. Exceptions are noted in the Client Detail pages.

Submit Medicaid claims:

• Electronically through eClaim on eyefinity.com.
• Via paper on a typewritten or computer-generated standard CMS-1500 form.
• Enter the authorization number in Box 23 of the CMS-1500 form. Use the appropriate Place of Service and Type of Service codes from your state Medicaid manual, and submit the CMS-1500 form directly to VSP for processing after providing services. It is not necessary to include the lab’s invoice for materials.

VSP will only reimburse claims received for patients who are eligible at the time of service.

Medicaid Repair and Replace/Interim Benefits

Effective June 1, 2025, you will be able to see eligibility and pull authorizations online for Medicaid members who are eligible for exam and materials under Repair and Replace/Interim benefits.  

Medicaid members with the Repair and Replace/Interim benefits can utilize this benefit when the primary benefit has been exhausted, within the same benefit period. 

The eClaim User Guide on the eyefinity.com eLearn tab will be updated with details, instructions, and screenshots by June 1, 2025.  

All Medicaid claims must be billed with the appropriate diagnosis codes:

Any exceptions are noted in the Client Detail pages.

Medical eyecare services performed in bordering states are reimbursed per Essential Medical Eye Care Medicaid fee schedule for the state in which you reside.

You are responsible for verifying the accuracy of your payment. For Medicaid patients, overpayments must be corrected within 60 days.