MedicaidCoverageMedium impact
Change to Adult Eyeglasses Benefit Effective July 1, 2012
Illinois Medicaid - HFS·IL · Optometry, Ophthalmology·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Effective July 1, 2012, Illinois Medicaid (HFS) limits adults 21 and older to one pair of eyeglasses every two years (730 days). Claims submitted before the two-year period expires will be rejected with error code F54.
Action Required
Billing team must update system to track eyeglass claims for adults 21+ using CPT codes 92340 and 92341, ensuring minimum 730-day gap between claims. Add eligibility verification step before submitting eyeglass claims to prevent F54 error code rejections. Eye exam and repair/refitting claims are not affected by this limitation.