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:
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 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.