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Vision care services are defined as those that are reasonable and necessary for the diagnosis and treatment of conditions of the visual system and the provision of lenses
and/or frames as applicable.
Recipients under 21 years of age, are limited to one full comprehensive eye examination is covered every 365 days. A complete set of glasses is provided every 365 days when medically necessary. Repairs and replacements during the year are not authorized. Beneficiaries are responsible for any loss of glasses or breakage not related to manufacturing defects.
Recipients over 21 years of age, are limited to one full comprehensive eye examination every 365 days. A complete set of glasses is covered only when subsequent to cataract surgery, detached retina surgery, corneal surgery, or glaucoma surgery.
If a beneficiary has cataract surgery or the prescription changes at least one-half diopter (0.50) during the 365-day period, only additional lenses (not frames) will be covered.
Refer to the Physicians, Laboratories, And Other Medical Professionals Provider Manual for a complete description of services and limitations.
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