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Billing Updates for Envolve Vision

Date: September 19, 2023

Attention: All Providers

Effective Date: October 1, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that Envolve Vision provides vision coverage for our CHIP, STAR and STAR Kids members up to 18 years old.

For your awareness, Envolve Vision's Clinical Policy for Routine (Preventive) Eye Examination (OC.UM.CP.0013) has recently been updated. The following changes will take effect for claims submitted on or after October 1, 2023:

  • Headache codes R51.0 and R51.9 have been removed from Envolve's list of medical indications for routine eye examinations (service codes: 92002, 92012, 92004, 92014, S0620, S0621). Visit the clinical policies page to review the updated policy.
  • ICD-10 codes R51.0 and R51.9 may be payable for other medical eye services. Please reference applicable clinical policies for a list of covered medical indications and corresponding plan specifics for routine and medical coding and coverage details.

CodeDescription
92002Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
92012Ophthalmological services; medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
92004Ophthalmological services; medical examination and evaluation, with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits
92014Ophthalmological services; medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
S0620Routine ophthalmological examination including refraction; new patient
S0621Routine ophthalmological examination including refraction; established patient

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.