Skip to main content
HealthPartners

Coverage criteria policies

Vision care services – Minnesota Health Care Programs

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for vision care services.

Coverage

Eyeglasses and vision care services are generally covered subject to the indications below.

Indications that are covered

  1. Comprehensive vision examinations.
  2. Intermediate vision examinations.
  3. Eyeglass coverage. Please see related content at right for link to Eyewear-DME-Minnesota Health Care Programs Coverage Policy.
  4. Contact lenses are covered when prescribed for aphakia, keratoconus, aniseikonia and for bandage lenses. Please see related content at right for link to Eyewear-DME -Minnesota Health Care Programs Coverage Policy.

Indications that are not covered

  1. Excluded services include contact lenses prescribed for reasons other than aphakia; keratoconus, aniseikonia or bandage lenses.
  2. Dispensing services related to a non-covered service.
  3. Services or materials that are considered experimental or not clinically proven by prevailing community standards or customary practice.

Definitions

Comprehensive vision examination: A complete evaluation of the visual system. The services include patient history, general medical observation, external and ophthalmoscopic examination, gross visual fields, basic sensorimotor examination, biomicroscopy, examination with cycloplegia or mydriasis, and tonometry.

Intermediate vision examination: An evaluation of a new or existing specific visual problem complicated with a new diagnosis or management problem not necessarily relating to the primary diagnosis.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

Reference

  1. MHCP Provider Manual Eyeglass and Vision Care Services - Revised 2-21-2017

.

Go to

Policy activity

  • 10/31/1994 - Date of origin
  • 10/20/2017 - Effective date
Review date
  • 10/2017
Revision date
  • 10/10/2017

Related content