MedicaidDocumentationMedium impact
Reminder Regarding Service and Supplies Limitations and Record Requirements in the Optometric Program
Illinois Medicaid - HFS·IL · Optometry·Provider Notice
Effective date
Mar 20, 2014
We identified it
Jun 20, 2026
Summary
This policy reminder reinforces existing requirements for optometric services including eye exam frequency limitations, lens power requirements, and eyeglass replacement limits. It emphasizes that providers must maintain complete records with signatures, and that inadequate documentation will result in payment denials and recoupment.
Action Required
Immediately: Optometry billing staff must verify all patient records include provider signatures for each service/visit. Update documentation requirements to ensure eye exam medical necessity is documented when billing for more than one exam per year. Verify lens prescriptions meet minimum power requirements (+/- 0.75 diopters for regular lenses, +/- 1.00 diopter for bifocals). Confirm adult patients over 21 are limited to one pair of eyeglasses every two years. Incomplete records will result in payment denials and recoupment.