MedicaidCoverageMedium impact
Attention Providers of Ocular Procedure Codes: Service Limitations Updated for Some Eye Examinations
Nevada Medicaid·NV · Ophthalmology, Optometry·Provider Announcement
Effective date
Dec 16, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has updated service limitations for 5 eye examination codes (92020, 92060, 92081, 92082, 92083) to allow only 3 times per rolling 12 months for physicians, APRNs, optometrists, and physician assistants. Claims exceeding this limit will deny with error code 5552, and prior authorization is still required for recipients aged 21 and older after the limit is exceeded.
Action Required
Immediately: Billing team must update system to track frequency limits for CPT codes 92020, 92060, 92081, 92082, and 92083 - maximum 3 times per rolling 12 months for Nevada Medicaid patients. Configure system to flag error code 5552 when limits are exceeded. Train staff to obtain prior authorization for patients aged 21+ when service limits are reached. Update encounter forms to remind providers of frequency restrictions.