Usage of DX V72.0 Optometry eye exams

by | Jul 10, 2012 | CPT modifiers


Active Duty Service Members (ADSMs)
• TRICARE Prime ADSMs must receive all vision care at a military treatment facility (MTF) unless specifically referred to a network provider (or non- network provider if a network provider is not available).

• TRICARE Prime Remote ADSMs may obtain comprehensive eye examinations from network providers as needed to maintain fitness- for-duty status without authorization.

Active Duty Family Members (ADFMs)
• One routine eye exam to check for vision and diseases per calendar year, regardless of TRICARE program option.

• Medically necessary care for injuries to the eye is covered. Retired Service Members and Their Dependents (includes all beneficiaries other than ADSMs and ADFMs)

• If enrolled in TRICARE Prime, one routine eye exam to check for vision and diseases every two years (except for diabetic patients, see “Diabetic Patients” in this figure).

• If using TRICARE Standard and TRICARE Extra or TRICARE For Life, no coverage (except for well-child benefit and diabetic patients, see “Well- Child Benefit” and “Diabetic Patients” in this figure).

• Medically necessary care for injuries to the eye is covered. Well-Child Benefit

For all TRICARE-eligible infants and children up to age 6:

• Infants may receive one eye and vision screening1 during routine exams at birth and at approximately 6 months under the well-child benefit.
Use V20.2 for eye exams under the well-child benefit.
• Children may receive two pediatric routine eye exams2 between the ages of 3 and 6 under the well-child benefit (use V20.2). 
Diabetic Patients
Diabetic patients at any age are allowed one routine eye examination each calendar year.
Note: For TRICARE Prime enrollees, a primary care manager (PCM) or TriWest referral is not needed, but TRICARE Prime beneficiaries must see an MTF or network optometrist or ophthalmologist. The V
code can be used for the annual exam; however, if a medical condition is identified, use medical diagnosis Current Procedural Terminology (CPT®) codes.