Medicare AdvantageCoverageHigh impact
Ophthalmology Examinations and Routine Eye Exams
Blue Cross Blue Shield of Rhode Island·RI · Ophthalmology, Optometry·Physician
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
BCBS Rhode Island updated its definition of routine eye exams for BlueCHiP Medicare members, making the first ophthalmology/optometry visit each calendar year automatically count as a routine exam with $0 copay, regardless of diagnosis. Claims processed with copays for first visits in 2019 will be automatically adjusted, requiring providers to refund collected copays within 45 days.
Action Required
Within 45 days of adjusted claim date (starting week of March 11): Billing team must refund any copays collected from BlueCHiP Medicare members for their first eye exam of 2019 using codes 92002-92014, S0620, or S0621. May apply refund toward outstanding patient balance instead of cash refund. Update billing system to recognize first annual eye exam automatically qualifies for $0 copay regardless of diagnosis.