N.J. Admin. Code § 10:62-2.6 - Standards and policies regarding lenses

Current through Register Vol. 54, No. 7, April 4, 2022

(a) Lenses 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/.
(b) Lenses shall meet impact resistant standards as set forth in the United States Food and Drug Administration regulations at 21 CFR 801.410.
(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 glasses.
(e) (Reserved)
(f) 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.
(g) 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 original prescription.
(h) (Reserved)
(i) (Reserved)
(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) below.
(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.
(l) 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.

Notes

N.J. Admin. Code § 10:62-2.6
Amended by 49 N.J.R. 2279(b), effective 7/17/2017

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