OAR 410-140-0160
Contact Lens Services and Supplies

(1) The following is general information regarding the Division’s contact lens services and supplies coverage for clients who receive services on a fee-for-services basis:

(a) The prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation, is only covered when provided by an optometrist or other qualified physician. Contact lens fitting by an independent technician in an optometry office is not a covered service; and

(b) Contact lenses shall be billed to the Division at the provider’s acquisition cost. Acquisition cost is defined as the actual dollar amount paid by the provider to purchase the item directly from the manufacturer or supplier plus any shipping and postage for the item. Payment for contact lenses is the lesser of the Division fee schedule or acquisition cost.

(2) Coverage for eligible adults (age 21 or older) as defined in OAR 410-140-0050 (Eligibility and Benefit Coverage):

(a) PA is required for contact lenses for adults, except for a primary keratoconus diagnosis;

(b) Contact lenses for adults are covered only when one of the following conditions exists:

(A) Refractive error which is 9 diopters or greater in any meridian;

(B) Keratoconus;

(D) Irregular astigmatism;

(E) Aphakia; or

(F) Post keratoplasty (e.g., corneal transplant), when medically necessary and within one year of procedure.

(c) Prescription and fitting of contact lenses is limited to once every 24 months. Replacement of contact lenses is limited to a total of two contacts every 12 months (or the equivalent in disposable lenses) and does not require PA.

(3) Coverage for Children (birth through age 20):

(a) Contact lenses for children are covered and are not limited when it is documented in the clinical record that glasses may not be worn for medical reasons, including, but not limited to:

(A) Refractive error which is 9 diopters or greater in any meridian;

(B) Keratoconus;

(D) Irregular astigmatism; or

(E) Aphakia;

(b) Replacement of contact lenses is covered when documented as medically appropriate in the clinical record and does not require PA.

(4) Contact lenses for treatment of disease or trauma (e.g., corneal bandage lens) are inclusive of the fitting. Follow up visits to determine eye health status may be separately reimbursed when the trauma or disease is clearly documented in the client record.

(5) An extra or spare pair of contacts is not covered.

Source: Rule 410-140-0160 — Contact Lens Services and Supplies, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-140-0160.

410‑140‑0020
Service Delivery 410‑140‑0040
Prior Authorization 410‑140‑0050
Eligibility and Benefit Coverage 410‑140‑0080
Medicare/Medicaid Assistance Program Claims 410‑140‑0120
ICD-10-CM Diagnosis, CPT/HCPCs Procedure Codes, and Modifiers 410‑140‑0140
Vision Services Coverage and Limitations 410‑140‑0160
Contact Lens Services and Supplies 410‑140‑0200
Dispensing, Fitting and Repair of Glasses 410‑140‑0260
Contractor Services for Provider Ordering Vision Materials and Supplies 410‑140‑0280
Vision Therapy Services 410‑140‑0300
Post-operative Care 410‑140‑0400
Contractor Services/Provider Ordering

California:	Codes
Colorado:	C.R.S.
Nevada:	NRS
New York:	Laws
Oregon:	OAR, ORS
Texas:	Statutes
World:	Rome Statute, International Dictionary

OAR 410-140-0160 Contact Lens Services and Supplies

OAR 410-140-0160
Contact Lens Services and Supplies