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SEND FORM TO Medicaid Prior Authorization ND Dept of Human Services 600 E Boulevard Ave Dept 325 Bismarck ND 58505-0250 REQUEST FORSERVICE AUTHORIZATION FOR VISION SERVICES NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES MEDICAL SERVICES DIVISION SFN 292 8-2014 Clear Fields FAX 701-328-1544 I.

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ND Medicaid covers the following lens styles: • Single vision; Flattop segments 28; • Round 22; • Flattop trifocals 7 x 28; • Executive style bifocals. ND Medicaid covers the following lens materials (no high index): • Glass; CR-39; • Polycarbonates.

Optometry Coding Guidelines 92004: This code refers to a medical evaluation and exam, including the initiation of the diagnosed treatment program. You may use this for comprehensive, new patient, or multiple visit occasions. 92002: This code refers to the statement above, though with intermediate occasions.

92004: Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits.

The American Medical Association owns the CPT codes. There are several evaluation and management procedural codes that could be used for an office visit to determine if the patient has an ocular, visual or visual perceptual problem. They include 92002, 92004, 92012, 92014, 99201-99205, or 99211-99215.

Claims billed with CPT codes 92071 (fitting of contact lens for treatment of ocular surface disease), 92072 (fitting of contact lens for management of keratoconus, initial fitting), 92310 (prescription of optical and physical characteristics of and fitting of contact lenses, with medical supervision of adaptation; ...

The comprehensive Eye visit codes (92004 and 92014) require all 12 elements of the examination (see checklist below), whereas you can submit the intermediate codes (92002 and 92012) if you've performed at least three, but fewer than 12, of them.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232