Military Health System

2.1  Lenses must be either approved for marketing by the United States (U.S.) Food and Drug Administration (FDA) or subject to an Investigational Device Exemption (IDE). See Chapter 8, Section 5.1.

2.2  Lenses or eye glasses are only cost-shared for the following conditions:

2.3  Benefits are also specifically limited to one set of lenses related to one of the qualifying eye conditions listed in paragraph 2.2. A set may also include a combination of both lenses and eyeglasses when a combination is necessary and related to one of the qualifying eye conditions.

2.4  When there is a prescription change still related to the qualifying eye condition, a new set are cost-shared, subject to medical review.

2.5  Reimbursement for a standard monofocal IOL covered under paragraph 2.2 is packaged into the payment for the extraction and lens implantation performed in a hospital on either an inpatient basis subject to the Diagnosis Related Group (DRG) reimbursement system (see the TRICARE Reimbursement Manual (TRM), Chapter 9, Section 1) or outpatient basis subject to Outpatient Prospective Payment System (OPPS) (see the TRM, Chapter 13, Section 3, paragraph 3.6.4.3) or in an Ambulatory Surgical Center (ASC) (see the TRM, Chapter 6, Section 4, paragraph 3.2). For a standard monofocal IOL inserted in a physician’s office, payment for the IOL is based upon the allowable charge basis.

3.1  When the prescription remains unchanged, replacement is not covered for lenses that are lost, have deteriorated or that have become unusable due to physical growth.

3.2  Adjustments, cleaning, or repairs of glasses are not covered (Current Procedural Terminology (CPT) procedure codes 92340 - 92371).

3.3  Astigmatism-Correcting Intraocular Lenses (A-C IOL) (V2787) and Presbyopia-Correcting Intraocular Lenses (P-C IOL) (V2788) are excluded from TRICARE coverage. Any adjustments, subsequent treatment, services or supplies required to examine and monitor the beneficiary who receives an A-C IOL or P-C IOL are also excluded. These items are excluded and the beneficiary is responsible for costs associated with these excluded lenses.