Contact lenses are considered for payment for any of the following indications:
A. Congenital aphakia
B. Acquired aphakia after cataract surgery (adult or pediatric);
C. Irregular corneas / corneal scarring when vision cannot be corrected with glasses (for example, keratoconus, after corneal graft surgery, after corneal infection);
D. As a corneal dressing to promote wound healing (eg, corneal ulcer / erosion, keratitis);
E. Refractive errors that cannot be corrected at a sharpness level of 20/40 with glasses.
F. Amblyopia when cannot be corrected otherwise.
Contact lenses are not considered for payment for the following conditions:
A. Albinism – as an alternative to polarized glasses to reduce sensitivity to light or severe photophobia;
B. Amblyopia- as an alternative to eye patches therapy / traditional pathing of the eye / occlusion or
C. Prior authorization in the correction of refractive errors instead of glasses, except as indicated above.
