# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 14 — Vision Care Services

#### Regulation .05 Limitations.

*COMAR 10.09.14.05*

A. The following are not covered:

  (1) Eyeglasses, ophthalmic lenses, optical aids, and optician services rendered to recipients 21 years old and older;

  (2) Eyeglasses, ophthalmic lenses, optical aids, and optician services rendered to recipients which were not ordered as a result of a full or partial EPSDT screen;

  (3) Repairs, except when repairs to eyeglasses are more cost-effective than replacing with new eyeglasses;

  (4) Combination or metal frames except when required for proper fit;

  (5) Cost of travel by the provider;

  (6) A general screening of a Medical Assistance population;

  (7) Visual training sessions which do not include orthoptic treatment;

  (8) Routine adjustment.

B. An optometrist certified by the Board as qualified to administer diagnostic pharmaceutical agents may use the following agents in strengths not greater than the strengths indicated:

  (1) Agents directly or indirectly affecting the pupil of the eye, including the mydriatics and cycloplegics listed below:

    (a) Phenylephrine hydrochloride (2.5 percent);

    (b) Hydroxyamphetamine hydrobromide (1 percent);

    (c) Cyclopentolate hydrochloride (0.5—2 percent);

    (d) Tropicamide (0.5 and 1 percent);

    (e) Cyclopentolate hydrochloride (0.2 percent) with Phenylephrine hydrochloride (1 percent);

    (f) Dapiprazole hydrochloride (0.5 percent); and

    (g) Hydroxyamphetamine hydrobromide (1 percent) and Tropicamide (0.25 percent); and

  (2) Agents directly or indirectly affecting the sensitivity of the cornea including the:

    (a) Topical anesthetics listed below:

      (i) Proparacaine hydrochloride (0.5 percent); and

      (ii) Tetracaine hydrochloride (0.5 percent); and

    (b) Diagnostic topical anesthetic and dye combinations listed below:

      (i) Benoxinate hydrochloride (0.4 percent) — Fluorescein sodium (0.25 percent); and

      (ii) Proparacaine hydrochloride (0.5 percent) — Fluorescein sodium (0.25 percent).

C. An optometrist certified by the Board as qualified to administer and prescribe topical therapeutic pharmaceutical agents is limited to:

  (1) Ocular antihistamines, decongestants, and combinations of them, excluding steroids;

  (2) Ocular antiallergy pharmaceutical agents;

  (3) Ocular antibiotics and combinations of ocular antibiotics, excluding specially formulated or fortified antibiotics;

  (4) Anti-inflammatory agents, excluding steroids;

  (5) Ocular lubricants and artificial tears;

  (6) Tropicamide;

  (7) Homatropine;

  (8) Nonprescription drugs that are commercially available; and

  (9) Primary open-angle glaucoma medications, in accordance with a written treatment plan developed jointly between the optometrist and an ophthalmologist.