MedicaidCoverageMedium impact
New Coverage Guidelines for CPT Code V2025 Deluxe Frames
Connecticut Medicaid (HUSKY Health)·CT · Ophthalmology, Optometry·Coding
Effective date
Feb 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has established new coverage criteria for deluxe eyeglass frames (HCPCS V2025) effective February 1, 2016. Claims for members 6+ years old must include specific diagnosis codes, and coverage is limited to one pair every two rolling years for members 21+ unless medically necessary due to condition changes.
Action Required
For Connecticut Medicaid patients: Update billing system to require diagnosis codes from Table 16 (found at ctdssmap.com) for all V2025 claims for members 6+ years old. Add claims history check process before dispensing frames to members 21+ to verify two-year benefit limit. Train staff on five medical necessity criteria and documentation requirements for deluxe frames.