Current through Register Vol. 54, No. 7, April 4, 2022
shall be first quality ophthalmic lenses meeting the requirements published by
American National Standard Institute (available from the American National
Standards Institute, 25 W. 43rd St, 4th floor, New York, NY 10036, tel.
212-642-4900, website http://www.ansi.org/
Lenses shall meet impact resistant
standards as set forth in the United States Food and Drug Administration
(c) For pricing purposes, all prescriptions
shall be written in minus cylinder form.
(d) The total correction shall be at least
0.50 diopter in spherical or cylindrical power in the initial prescription for
Contact lenses may be provided for:
1. Specific ocular pathological conditions
including, but not limited to, Keratoconus, monocular surgical aphakia to
effect binocular vision, anisometropia of 3.0 diopters or more; and
2. Patients whose vision cannot be improved
to at least 20/70 with regular lenses but improvement of vision can be
accomplished to 20/70 or better.
The policy for duplication or
reproduction of the same correction is as follows:
1. A re-examination and new prescription are
required if more than one year (or two years in the case of an individual 19
through and including 59 years of age) has elapsed since the date of the
(j) Polycarbonate lenses
(Y5201) may be provided in special situations when maximum protection is
indicated and recommended in writing by the prescribing practitioner, but not
in conjunction with the ultraviolet filter lens described in (k)
(k) Ultraviolet filter lens
(V2755) may be provided in special situations when maximum ultraviolet
protection is indicated for the preservation of tissue integrity and
recommended in writing by the prescribing practitioner, but not in conjunction
with the polycarbonate lens described in (j) above.
The following are not covered under the
New Jersey Medicaid/NJ FamilyCare fee-for-service programs:
1. Gradient tint;
2. Photochromatic lenses;
3. Prescription sunglasses;
4. Rimless lenses; and
5. Temporary glasses.