Mississippi Division Of Medicaid VISION FEE SCHEDULE
Mississippi Division of MedicaidVISION FEE SCHEDULECOVER SHEETAdditional References:MS Division of Medicaid WebsiteMS Envision Interactive Fee ScheduleMS Envision Downloadable Fee ScheduleMedicaid National Correct Coding Initiative (NCCI) EditsNote NumberColumn Title1CodeDetails Healthcare Common Procedure Coding System (HCPCS) or Current ProceduralTerminology (CPT) Code2Description Short Descriptor for the Healthcare Common Procedure Coding System (HCPCS) orCurrent Procedural Terminology Code Clinical Description This column identifies the codes that require prior authorization before the service isperformed.3Prior Authorization4Min Age This column is the covered minimum age for the service.5Max Age This column is the covered maximum age for the service.6Begin Date7End Date This column represents the end date of the fee segment in columns I.8Max Units This column represents the maximum units the Division of Medicaid covers for theservice. Priced by PA (prior authorization) - require a prior authorization with the invoice submittalto Fiscal Agent for approval prior to service(s) rendered. This column represents the begin date of which the fee in columns I became effective. This column is the maximum amount that Division of Medicaid will pay foreach unit.9Fee When the maximum fee listed is 0.00, the provider must request prior authorizationand/or submit a By Report claim, as identified on the fee schedule. MP - Mannually Priced, the provider must submit a By Report claim, as identified on thefee schedule to determine appropriate payment. NC - Non Covered Service
Mississippi Division of MedicaidVISION FEE SCHEDULEPrint Date: JULY 1, 2021The fee schedules located on the Mississippi Medicaid website are prepared to assist Medicaid providers and are not intended to grant rights or impose obligations. Every effort ismade to assure the accuracy of the information within the fee schedules as of the date they are posted. Medicaid makes no guarantee that this compilation of fee scheduleinformation is error-free and will bear no responsibility or liability for the results or consequences of the use of these schedules.**Units are subject to change upon Agency review.****Price does not include cutbacks, assessment fees, etc. Payment is not guaranteed**The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright 2020 American Medical Association and 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS iptionEye exam new patientEye exam new patientEye exam establish patientEye exam&tx estab pt 1/ vstDetermine refractive stateNew eye exam & treatmentEye exam & treatmentSpecial eye evaluationCorneal topographySpecial eye evaluationOrthoptic/pleoptic trainingContact lens fitting for txFit contac lens for managmntVisual field examination(s)Visual field examination(s)Visual field examination(s)Serial tonometry exam(s)Cmptr ophth dx img ant segmtCmptr ophth img optic nerveCptr ophth dx img post segmtOphthalmic biometryCorneal hysteresis deterOpscpy extnd rta draw uni/biOpscpy extnd on/mac drawRemote dx retinal imagingRemote retinal imaging mgmtImg rta detc/mntr ds poc alyEye exam with photosFluorescein angrph uni/biIcg angiography uni/biFluorescein icg angiographyEye exam with photosOphthalmoscopy/dynamometryEye muscle evaluationSensori-Neural Visual TherapyElectro-oculographyFull field erg w/i&rMultifocal erg w/i&rColor vision examinationDark adaptation eye examEye photographyInternal eye photographyInternal eye photographyContact lens fittingContact lens fittingContact lens fittingContact lens fittingPrescription of contact lensRx cntact lens aphakia 1 eyeRx cntact lens aphakia 2 eyeRx corneoscleral cntact lensModification of contact lensReplacement of contact lensFit spectacles monofocalFit spectacles bifocalFit spectacles multifocalFit aphakia spectcl SYESYESYESNONONONOYESYESNONONONOMin 0000000000Page 2 of 5Max 9999999999999999999920Begin /20207/1/2020End 999912/31/999912/31/9999Max C34.6429.3728.6733.2935.7635.61
Mississippi Division of MedicaidVISION FEE SCHEDULEPrint Date: JULY 1, 2021The fee schedules located on the Mississippi Medicaid website are prepared to assist Medicaid providers and are not intended to grant rights or impose obligations. Every effort ismade to assure the accuracy of the information within the fee schedules as of the date they are posted. Medicaid makes no guarantee that this compilation of fee scheduleinformation is error-free and will bear no responsibility or liability for the results or consequences of the use of these schedules.**Units are subject to change upon Agency review.****Price does not include cutbacks, assessment fees, etc. Payment is not guaranteed**The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright 2020 American Medical Association and 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS 8V2121Fit aphakia spectcl multifocFit spectacles single systemFit spectacles compound lensAphakia prosth service tempRepair & adjust spectaclesRepair & adjust spectaclesVision svcs frames purchasesEyeglasses delux framesFrames, Repair or Part ReplacementLens spher single plano 4.00Single visn sphere 4.12-7.00Singl visn sphere 7.12-20.00Spherocylindr 4.00d/12-2.00dSpherocylindr 4.00d/2.12-4dSpherocylinder 4.00d/4.25-6dSpherocylinder 4.00d/ 6.00dSpherocylinder 4.25d/12-2dSpherocylinder 4.25d/2.12-4dSpherocylinder 4.25d/4.25-6dSpherocylinder 4.25d/over 6dSpherocylindr 7.25d/.25-2.25Spherocylindr 7.25d/2.25-4dSpherocylindr 7.25d/4.25-6dSpherocylinder over 12.00dLens lenticular bifocalLens aniseikonic singleLenticular lens, singleV2199Lens single vision not oth 1Lens spher bifoc plano 4.00dLens sphere bifocal 4.12-7.0Lens sphere bifocal 7.12-20.Lens sphcyl bifocal 4.00d/.1Lens sphcy bifocal 4.00d/2.1Lens sphcy bifocal 4.00d/4.2Lens sphcy bifocal 4.00d/oveLens sphcy bifocal 4.25-7d/.Lens sphcy bifocal 4.25-7/2.Lens sphcy bifocal 4.25-7/4.Lens sphcy bifocal 4.25-7/ovLens sphcy bifo 7.25-12/.25Lens sphcyl bifo 7.25-12/2.2Lens sphcyl bifo 7.25-12/4.2Lens sphcyl bifocal over 12.Lens lenticular bifocalLens aniseikonic bifocalLens bifocal seg width overLens bifocal add over 3.25dLenticular lens, bifocalV2299Lens bifocal specialityV2300V2301V2302V2303V2304V2305Lens sphere trifocal 4.00dLens sphere trifocal 4.12-7.Lens sphere trifocal 7.12-20Lens sphcy trifocal 4.0/.12Lens sphcy trifocal 4.0/2.25Lens sphcy trifocal 4.0/4.25PAMin AgeMax AgeBegin 999912/31/999912/31/999912/31/999912/31/9999End DateMax 2334.6736.0837.6540.2540.4448.9520.7417.5346.95YES - Pricedby ONONONONOYES - Pricedby 0000000000000000000Page 3 of 9999999999999999999999999999Fee
Mississippi Division of MedicaidVISION FEE SCHEDULEPrint Date: JULY 1, 2021The fee schedules located on the Mississippi Medicaid website are prepared to assist Medicaid providers and are not intended to grant rights or impose obligations. Every effort ismade to assure the accuracy of the information within the fee schedules as of the date they are posted. Medicaid makes no guarantee that this compilation of fee scheduleinformation is error-free and will bear no responsibility or liability for the results or consequences of the use of these schedules.**Units are subject to change upon Agency review.****Price does not include cutbacks, assessment fees, etc. Payment is not guaranteed**The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright 2020 American Medical Association and 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS NONONONONOMin AgeMax AgeBegin 1/1/19941/1/2004End 999912/31/999912/31/999912/31/999912/31/9999Max UnitsLens sphcyl trifocal 4.00/ 6Lens sphcy trifocal 4.25-7/.Lens sphc trifocal 4.25-7/2.Lens sphc trifocal 4.25-7/4.Lens sphc trifocal 4.25-7/ 6Lens sphc trifo 7.25-12/.25Lens sphc trifo 7.25-12/2.25Lens sphc trifo 7.25-12/4.25Lens sphcyl trifocal over 12Lens lenticular trifocalLens aniseikonic trifocalLens trifocal seg width 28Lens trifocal add over 3.25dLenticular lens, 68V2399Lens trifocal specialityYES - Pricedby PA099910/1/200312/31/999920V2410V2430Lens variab asphericity singLens variable asphericity 2242.6352.96V2499Variable asphericity lensYES - Pricedby 31Contact lens pmma sphericalCntct lens pmma-toric/prismContact lens pmma bifocalCntct lens pmma color visionCntct gas permeable sphericlCntct toric prism ballastCntct lens gas permbl bifoclContact lens extended wearContact lens hydrophilicCntct lens hydrophilic toricCntct lens hydrophil bifoclCntct lens hydrophil extendCntct Lens Hydrophil PhotochContact lens gas impermeableContact lens gas 4871.34NC104.0653.45V2599Contact lens/es other typeYES - Pricedby PA099910/1/200312/31/999920V2600Hand held low vision aidsYES - Pricedby PA02011/1/200612/31/999910V2610Single lens spectacle mountYES - Pricedby 6V2627V2628V2629Telescop/othr compound lensPlastic eye prosth customPolishing artifical eyeEnlargemnt of eye prosthesisReduction of eye prosthesisScleral cover shellFabrication & fittingProsthetic eye other 99999991NC434.7854.19351.02222.7NCNCNCV2630Anter chamber intraocul lensYES - Pricedby PA099910/1/200312/31/999910V2631Iris support intraoclr lensYES - Pricedby PA099910/1/200312/31/99991000000000000000Page 4 of 5999999999999999999999999999999999999999999Fee
Mississippi Division of MedicaidVISION FEE SCHEDULEPrint Date: JULY 1, 2021The fee schedules located on the Mississippi Medicaid website are prepared to assist Medicaid providers and are not intended to grant rights or impose obligations. Every effort ismade to assure the accuracy of the information within the fee schedules as of the date they are posted. Medicaid makes no guarantee that this compilation of fee scheduleinformation is error-free and will bear no responsibility or liability for the results or consequences of the use of these schedules.**Units are subject to change upon Agency review.****Price does not include cutbacks, assessment fees, etc. Payment is not guaranteed**The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright 2020 American Medical Association and 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.CodeDescriptionPAMin AgeMax AgeBegin DateEnd DateMax UnitsFeeV2632Post chmbr intraocular lensYES - Pricedby 70V2780V2781Balance lensDeluxe lens featureGlass/plastic slab off prismPrism lens/esFresnell prism press-on lensSpecial base curveTint photochromatic lens/esTint, any color/solid/gradAnti-reflective coatingUv lens/esEye glass caseScratch resistant coatingMirror coatingPolarization, any lensOccluder lens/esOversize lens/esProgressive lens per 914.1910.356.84NC7.67NCNCNCNC11.077.68NCV2782Lens, 1.54-1.65 p/1.60-1.79gYES - Pricedby PA0201/1/200412/31/999920V2783Lens, 1.66 p/ 1.80 gYES - Pricedby PA0201/1/200412/31/999920V2784Lens polycarb or equalYES - Pricedby V2797Corneal tissue processingOccupational multifocal lensAstigmatism-correct functionPresbyopia-correct functionAmniotic membraneVis item/svc in other 11111NCNCNCNCNCNCV2799Misc vision item or serviceYES - Pricedby PA099910/1/200312/31/999920Page 5 of 5
Jul 01, 2021 · 92310 Contact lens fitting YES 0 999 7/1/2020 12/31/9999 1 83.18 92311; Contact lens fitting YES 0 999 7/1/2020 12/31/9999 1 86.09 92312 Contact lens fitting YES 0 999 7/1/2020 12/31/9999 1 99.86 92313; Contact lens fitting YES 0 999 7/1/2020 12/31/9999 1 80.55 92314 Prescriptio
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The Mississippi State Board of Education, the Mississippi Department of Education, the Mississippi School for the Arts, the Mississippi School for the Blind, the Mississippi School for the Deaf, and the Mississippi School for Mathematics and Science do not discriminate on the
The Mississippi State Board of Education, the Mississippi Department of Education, the Mississippi School for the Arts, the Mississippi School for the Blind, the Mississippi School for the Deaf, and the Mississippi School for Mathematics and Science do not discriminate on the
and associations of local government in their efforts to improve governance at the grassroots and to deliver services to the citizens of Mississippi. The center does not take an advocacy role in the Mississippi State University Extension Service Municipal Government in Mississippi Mississippi. Mississippi.
The 33rd Annual Mississippi Water Resources Conference was held April 23-24, 2003 at the Eagle Ridge Conference Center in Raymond, Mississippi. CONFERENCE SPONSORS: Mississippi Water Resources Research - GeoResources Institute U.S. Geological Survey, Mississippi District Office Mississippi Department of Environmental Quality's Offices of Land and
Mississippi House Bill 71 -2009 Second Extraordinary Session Mississippi House Bill 421 -2012 Regular Session Mississippi House Bill 1275 -2014 Regular Session The MississippiCAN program has evolved from January 2011 to present. o Increased limit to the greater of: o 45% of total enrollment of Medicaid beneficiaries, or
To enhance the integrity of the Mississippi Medicaid program by preventing and detecting fraudulent, abusive and wasteful practices within the Medicaid program, assuring compliance by all providers and vendors, and recovering improperly expended Medicaid funds while promoting ac
