3.2 For Active Duty Family Members
(ADFMs) payment can be made for one routine eye examination per
year.
3.2.1 Routine eye examinations as defined in
32 CFR 199.2 includes coverage of those services rendered
in order to determine the refractive state of the eyes. The Current
Procedural Terminology (CPT) procedure codes for payment of routine
eye examinations are as follows:
92002
- EYE EXAM, NEW PATIENT
92004
- EYE EXAM, NEW PATIENT
92012 - EYE EXAM, ESTABLISHED PATIENT
92014 - EYE EXAM & TREATMENT
92015 - REFRACTION
99172 - OCULAR FUNCTION SCREEN
99173 - VISUAL ACUITY SCREEN
3.2.2 TRICARE
Prime and Standard (through December 31, 2017) and
TRICARE Select (starting January 1, 2018) ADFMs are
entitled to one annual routine eye examination.
Prime ADFMs may receive their annual routine eye examination from
any network provider without referral, authorization, or preauthorization
from the Primary Care Manager (PCM), or any other authority; i.e.,
a Prime ADFM will be allowed to set up his or her own appointment
for a routine eye examination with any network optometrist or ophthalmologist.
Standard (through December 31, 2017) and TRICARE Select
(starting January 1, 2018) ADFMs may self-refer to
any TRICARE authorized provider regardless of whether or not they
are a network provider; i.e., they may
set up his or her own appointment with either a network or non-network,
TRICARE authorized, optometrist or ophthalmologist.