Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2

Affected: IC 12-13-7-3; IC 12-15; IC 25-24-1-4

Sec. 3. The following services, if medically necessary, may be provided in addition to the initial examination:

1. (1) Supplemental evaluation.
2. (2) Multiple pattern fields, including Roberts, Harrington, or Flods.
3. (3) Central field study.
4. (4) Peripheral field study.
5. (5) Tangent screen study.
6. (6) Color field study.
7. (7) Binocular ophthalmoscope.
8. (8) Other supplemental testing.
9. (9) Visual skills study.
10. (10) Clinical photography.
11. (11) Bifocal determination.
12. (12) Trifocal determination.
13. (13) Definitive fundus evaluation.
14. (14) Electrophysiology.
15. (15) Gonioscopy.
16. (16) Out-of-office visits.
17. (17) Neutralization of lens or lenses.
18. (18) Neutralization of contact lenses.
19. (19) Extended ophthalmoscopy.
20. (20) Serial tonometry.
21. (21) Refractions.
22. (22) Office visit.
23. (23) Consultation.
24. (24) Visual skills testing.

Screening services (excluding EPSDT) for members are not covered by Medicaid, and payment will not be made for such care. All services provided to recipients in long term care facilities must be documented in the recipient medical record that is maintained by the facility.

(Office of the Secretary of Family and Social Services; 405 IAC 5-23-3; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3343; filed Sep 27, 1999, 8:55 a.m.: 23 IR 318; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; readopted filed Jul 28, 2022, 2:21 p.m.: 20220824-IR-405220205RFA; readopted filed May 30, 2023, 11:54 a.m.: 20230628-IR-405230292RFA)