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.