1. Vision update
September 2016

2. Vision codes
The Bureau for Medical Services has reached a decision to remove the recent prior authorization requirement on the following CPT codes:
92002, 92004, 92012, 92014, 92018, and
Effective September 1, 2016.
Prior Authorization is NOT required on these codes.

3. Vision Services- 525.1.1 eye examinations
Children up to 21 Years of Age:
Eye examination(s) are based upon Early Periodic Screening, Diagnosis and Treatment (EPSDT) referral(s), American Academy of Pediatrics (AAP) and Bright Futures requirements.
Adults 21 Years of Age or Greater:
Eye Examinations are limited to comprehensive exam/evaluation for medical necessity only. Visual examinations to determine the need for eyeglasses are covered for children only. Additionally, diagnostic evaluations and examinations may be reimbursed when documentation in the medical record justifies the medical need for more frequent exams.
The Provider Manual can be located at

4. Plan of action
KEPRO, Molina, and BMS will place announcements on their websites.
BMS has updated the Vision Chapter in the Provider Manual to remove the Vision PA requirement on these codes.
Molina has removed the PA requirement on these codes and will reprocess claims back to May 1, 2016.

5. Vision prior authorizations
As of September 1, 2016 we began faxing back prior authorization requests for the Vision Codes: 92002, 92012, 92014, 92018, and
KEPRO will remove these codes from their production system and from the listing of codes requiring prior authorization.
Cases submitted via DDE (direct data entry) after September 1, 2016 will be closed administratively.

6. Molina contact information
Member Services (888) ; (304)
Provider Services (888) ; (304)
Provider Field Representative:
Debbie Rhodes
Freda Creighton
Gloria Hays
James Wallace
Christina Martin
Cary Johnson

7. Kepro Contact information
Medical Services General Voic ext Medical Services Helen Snyder Associate Director EXT Angela Hobbs UM Nurse Supervisor EXT Alicia Perry Office Manager EXT Cindy Bunch Eligibility Specialist EXT Tonya Tacy Eligibility Specialist EXT Jasper Smith Eligibility Specialist EXT Justin Vanwyck Training Specialist EXT Sierra Hall Training Specialist EXT GENERAL KEPRO INFORMATION: Fax #: (Registration and Technical Support only) Website for Submitting Authorizations: Website for Org Managers to Add/Modify Users REMEMBER: us at to be added to our list. This will ensure you receive important information and announcements directly.