Back to Top Skip to main content the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

Alert Arrow ALERT!!

MONTHLY MAINTENANCE: The DHA network is scheduled for monthly maintenance on Saturday, January 22nd at 6:00am (EST) until Sunday, January 23rd at 11:59pm (EST). The TRICARE Manuals web site may be available intermittently during this period but its usage is not recommended.

TRICARE Policy Manual 6010.63-M, April 2021
Chapter 7
Section 6.1
Ophthalmological Services
Issue Date:  November 3, 1992
Authority:  32 CFR 199.4(c)(2)(xvi), (e)(6), (g)(46), (g)(50), and 10 USC 1079(a)(3)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
92002 - 92060, 92070 - 92335, 92390 - 92499
Ophthalmological services may include an examination and other specialized services. The purpose of an examination is to diagnose or treat a medical condition of the eye, eyelid, lacrimal system, or orbit. A “routine eye examination” is an evaluation of the eyes, including but not limited to refractive services, that is not related to a medical or surgical condition or to the medical or surgical treatment of a covered illness or injury.
3.1  For all beneficiaries, ophthalmological services (including refractive services) provided in connection with the medical or surgical treatment of a covered illness or injury are covered.
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) codes for payment of routine eye examinations are as follows:
3.2.2  TRICARE Prime and TRICARE Standard (through December 31, 2017) and TRICARE Select (starting January 1, 2018) ADFMs are entitled to one annual routine eye examination. TRICARE 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 TRICARE Prime ADFM will be allowed to set up his or her own appointment for a routine eye examination with any network optometrist or ophthalmologist. TRICARE 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.
3.3  For Prime enrollees, see Section 2.2 for additional information on routine eye examinations.
3.4  Heidelberg Retina Tomograph (HRT), and Scanning laser polarimetry (GDx) (CPT code 92135) to diagnose and monitor progression of suspected glaucoma may be cost-shared. Optical Coherence Tomograph (OCT) to diagnose and monitor progression of suspected retinal disease may be considered for cost-sharing. Effective October 28, 2008.
3.5  Vision home monitoring with preferential hyperacuity perimetry (ForeseeHome™ Monitoring Device) (CPT codes 0378T-0380T) to monitor the progression of intermediate or advanced age-related macular degeneration in patients 65 years of age or older, may be cost-shared. Effective November 11, 2013.
4.0  Related TRICARE Policies
For reimbursement of instrument-based vision screenings for children age one to age six when provided by a physician other than an ophthalmologist or optometrist as part of a well-child care program, see Section 2.5.
5.1  Routine eye examinations are NOT covered for Standard (through December 31, 2017)/TRICARE Select (starting January 1, 2018) retirees or their dependents that are not enrolled in TRICARE Prime except for eye exams allowed under the well-child benefit in Section 2.5.
5.2  Orthoptics, also known as vision training, vision therapy, eye exercises, eye therapy, is excluded by 32 CFR 199.4(g)(46) (CPT code 92065).
- END -

Utility Navigation Links

DoD Seal is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Frequently Asked Questions page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.


DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.