Applies to:

All plans

Medicare plans follow Medicare coverage and billing rules

Medical policy

• Vision Care - 91538

Medical vision services are covered by the member's medical benefit and billed with medical diagnosis codes, such as diabetic retinal exams and treatment for macular degeneration. Medical vision benefits are available in the Member Inquiry tool.

Cataract surgery: See Medical/surgical services > Cataract surgery.

Diabetic retinal exams are covered by all Priority Health plans as a medical benefit.

Refraction with a medical diagnosis: Not covered.