Updated Vision Benefit Codes

Attention: Optometrists and ophthalmologistsEffective Date: March 9, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: Texas Children’s Health PLAN (TCHP) would like to inform network providers of the updated benefit codes for vision services. These services are categorized as either a routine or a medical benefit and identified by the diagnosis codes. The following diagnosis codes utilized for ordering glasses: H52                    H52.1           H52.20            H52.211          H52.222 H52.0              H52.10            H52.201          H52.212          H52.223 H52.00            H52.11            H52.202          H52.213          H52.229 H52.01            H52.12            H52.203          H52.219          H52.4 H52.02            H52.13            H52.209          H52.22            H52.6 H52.03            H52.2              H52.21            H52.221          H52.7 The following diagnosis codes are medical related: H52.3               H52.511          H52.521          H52.531 H52.31             H52.512          H52.522          H52.532 H52.32             H52.513          H52.523          H52.533 H52.5               H52.519          H52.529          H52.539 H52.51             H52.52            H52.53 The following diagnosis codes are routine related: Z01.0   Z01.00   Z01.01 The diagnosis codes for glasses and routine related are covered under the routine vision benefit. The diagnosis codes for medical related are covered under the medical vision benefit. Next steps for providers: No action required. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.