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.