MedicaidCoverageMedium impact
Clarification of coverage for vision exams and corrective lenses
Oregon Health Plan·OR · Optometry, Ophthalmology, Family Medicine +1 more·Plan contract
Effective date
Apr 25, 2023
We identified it
Jun 20, 2026
Summary
Oregon Health Authority clarified vision exam and corrective lens coverage for Medicaid members. Routine eye exams are covered once every 24 months for adults 21+ with OHP Plus, and when clinically appropriate for members under 21 and CWM Plus members. Corrective lenses are only covered for members under 21, pregnant members, or those with specific conditions per OAR 410-140-0140.
Action Required
Immediately: Billing team must verify vision exam frequency limits in system - limit routine eye exams to once every 24 months for OHP Plus adult members (21+). Update coverage verification procedures to check member age, pregnancy status, or qualifying conditions per OAR 410-140-0140 before billing corrective lenses. Train front desk staff on new coverage criteria to prevent claim denials.