Provider Alert! Vision Services-Nonsurgical Benefits to Change

Date: August 25, 2021

Attention: Optometrists and Ophthalmologists

Effective Date: September 1, 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: Effective September 1, 2021, Texas Children’s Health Plan(TCHP) will implement the Vision Services benefit changes outlined in the TMHP Bulletin Vision Services-Nonsurgical Benefits to Change Effective September 1, 2021.  Below are some of the changes and some exceptions.

How this impacts providers: Updates included in the bulletin:

• The limit for code 92201 and 92202 has been increased from 2 services to 12 services per lifetime for ALL ages.
• The limits have been updated for codes 76514, 76519, 92136, 92065, 92071, 92134, V2410, and V2430.
• The diagnosis codes have been updated for codes 76514, 92020, and V2784.
• The place of service (POS) and provider type restrictions have been updated for codes 92025 (for mod 26), 92065, 92227, 92228, 92230, 92235, 92240, 92242, 92250, 92260, 92285, V2221, and V2799.

TCHP exceptions:

• Medically necessary eye exams will be restricted to Ophthalmologists and Optometrists based on information in Section 4.3.5.2 of Vision and Hearing Services Handbook (TMPPM).
• TCHP will not require prior authorization for codes 92071 and 92072.

Next steps for providers: Providers should share this communication with their staff.

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.