Contact Lens Benefit for the Montana HELP Plan

Feb. 17, 2017

Effective January 1, 2017, the following contact lens services will be eligible for reimbursement under the Montana HELP Plan:

Contact lens exam and fittings and contact lenses for the diagnosis of keratoconus, aphakia, anisometropia of two diopters or more or if the sight cannot be corrected to 20/40 with eyeglasses. Preauthorization is required for contact lens exams and fittings and contact lenses.

The following contact lens exam/fitting codes, when preauthorized, will be allowed: 92071,92072, 92310, 92311, 92312, 92313, 92314, 92315, 92316, 92317, 92325 and 92326. These codes are only allowed with one of the following diagnoses:

  1. Keratoconus — protrusion of the center of the cornea
  2. Aphakia — absence of the lens of an eye
  3. Anisometropia of 2 diopters or more — refractive power of one eye differs from the other eye
  4. Sight cannot be corrected to 20/40 with eyeglasses

The following covered codes for the supply of contacts are: V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523 (paid under Medicaid Fee Schedule) and V2599 (paid at invoice cost).

If services are not preauthorized, they are not covered.

Any claims for contact lens exams and fittings and contact lenses that have denied will be adjusted for payment, as long as the outlined criteria applies and the appropriate preauthorization has been received.