Provider Alert! Updated Vision Benefit Codes
Attention: Optometrists and ophthalmologists
Effective Date: March 9, 2021
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Texas Children’s Health PLAN (TCHP) would like to inform network providers of the updated benefit codes for vision services. These services are categorized as either a routine or a medical benefit and identified by the diagnosis codes.
The following diagnosis codes utilized for ordering glasses:
H52 H52.1 H52.20 H52.211 H52.222
H52.0 H52.10 H52.201 H52.212 H52.223
H52.00 H52.11 H52.202 H52.213 H52.229
H52.01 H52.12 H52.203 H52.219 H52.4
H52.02 H52.13 H52.209 H52.22 H52.6
H52.03 H52.2 H52.21 H52.221 H52.7
The following diagnosis codes are medical related:
H52.3 H52.511 H52.521 H52.531
H52.31 H52.512 H52.522 H52.532
H52.32 H52.513 H52.523 H52.533
H52.5 H52.519 H52.529 H52.539
H52.51 H52.52 H52.53
The following diagnosis codes are routine related:
Z01.0 Z01.00 Z01.01
The diagnosis codes for glasses and routine related are covered under the routine vision benefit.
The diagnosis codes for medical related are covered under the medical vision benefit.
Next steps for providers: No action required.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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