<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.14.06" title_num="10" subtitle_num="09" chapter_num="14" heading="Preauthorization Requirements.">
  <paragraph num="A.">
    <text>The following services require written preauthorization:</text>
    <paragraph num="(1)">
      <text>Optometric examinations to determine the extent of visual impairment or the correction required to improve visual acuity before expiration of the normal time limitations;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Replacement of eyeglasses due to medical necessity or because the eyeglasses were lost, stolen, or damaged before expiration of the normal time limitations;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Contact lenses;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Subnormal vision aid examination and fitting;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Orthoptic treatment sessions;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Plastic lenses costing more than equivalent glass lenses unless there are six or more diopters of spherical correction or three or more diopters of astigmatic correction;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Absorptive lenses, except cataract;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Ophthalmic lenses or optical aids when the diopter correction is less than:</text>
      <paragraph num="(a)">
        <text>-0.50 D. sphere for myopia in the weakest meridian;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>+0.75 D. sphere for hyperopia in the weakest meridian;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>+0.75 additional for presbyopia;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>±0.75 D. cylinder for astigmatism;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A change in axis of 5° for cylinders of 1.00 diopter or more;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>A total of 4 prism diopters lateral or a total of 1 prism diopters vertical.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Preauthorization is issued when:</text>
    <paragraph num="(1)">
      <text>Program procedures are met;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Program limitations are met;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The provider submits to the Department adequate documentation demonstrating that the service to be preauthorized is medically necessary.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Preauthorization is valid only for services rendered or initiated within 60 days of the date issued.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Preauthorization normally required by the Program is waived when the service is covered and approved by Medicare. However, if the entire or any part of a claim is rejected by Medicare, and the claim is referred to the Program for payment, payment will be made for services covered by the Program only if authorization for those services has been obtained before billing. Non-Medicare claims require preauthorization according to §§A — C of this regulation.</text>
  </paragraph>
</regulation>