Additional comprehensive exams, if medically necessary, may be reimbursed if the provider has requested and received PA.
Supplemental tests are included in the reimbursement rate that is set for comprehensive or low vision examinations and are not separately reimbursable on the same DOS as a comprehensive or low vision examination.
Optometrists and ophthalmologists may be reimbursed for laboratory tests billed as a "complete" procedure or for the professional component only (using modifier "26"). A complete procedure includes both the professional and technical components. A vision provider may not be reimbursed for the technical component only.
Under Wisconsin Medicaid and BadgerCare Plus, a refraction service (procedure code 92015) performed by an ophthalmologist or optometrist is reimbursed when it is billed either separately or when it is billed with a general ophthalmological examination for new and established patients (procedure codes 92002, 92004, 92012, and 92014).
The Covered and Noncovered Services section includes additional information on covered vision services.