MedicaidPrior AuthMedium impact
Prior Approval Changes for Polycarbonate Lense
Illinois Medicaid - HFS·IL · Optometry, Ophthalmology·Provider Notice
Effective date
Sep 1, 2006
We identified it
Jun 21, 2026
Summary
Starting September 1, 2006, providers must follow a new three-form process for polycarbonate lens prior approval requests, as the Illinois Department of Corrections lab will now manufacture these lenses instead of authorizing outside payments. The process requires completing DPA 1409, HFS 1443, and DPA 2803 forms together.
Action Required
By September 1, 2006: Optometry and physician billing teams must update polycarbonate lens prior approval workflow to submit three forms together (DPA 1409 with HCPCS V2784, HFS 1443 with CPT 92340 dispensing fee, and DPA 2803 with polycarbonate checkbox marked). Update staff training on new DOC lab manufacturing process. Claims without all three forms will be denied.