News & Events: Details
EPSDT Eyeglass Coverage Reminder
06/09/2022
As a reminder, vision services are covered for all AHCCCS EPSDT (Early Periodic Screening, Diagnostic and Treatment) members under 21 years of age.
Covered vision services for all these members include:
- regular eye exams and vision screenings
- prescription eyeglasses
- updates to a members eyeglass prescription
- unlimited repair or replacement of optical aids when medically necessary
- any special additions (e.g. lenses) when medically necessary
We continue to receive concerns that members encounter difficulties in receiving these services and that members are improperly denied medically necessary services.
Providers should avoid any practice involving “upsales” or any additional service that may involve financial exposure for the member. Providers should also avoid activities that promote the purchase of insurance or warranty plans to members because broad coverage is available through AHCCCS. In addition, any discussion with the family that may result in additional costs to Banner – University Family Care-enrolled members shall not take place until the provider has discussed this and obtained prior approval by Banner – University Family Care.
Vision providers are also required to post information regarding eyeglass related coverage requirements for EPSDT members on their websites. Click here to view the 2-page flyer from AHCCCS about vision coverage which could be used as the basis for this post.
If you have any questions, please reach out to the Provider Experience Center at 800-582-8686.