WAC 388-544-0550
Vision care -- Covered eye surgery. (1)
The department covers cataract surgery, without prior
authorization, when the following clinical criteria are met:
(a) Correctable visual acuity in the affected eye at
20/50 or worse, as measured on the Snellen test chart; or
(b) One or more of the following conditions:
(i) Dislocated or subluxated lens;
(ii) Intraocular foreign body;
(iii) Ocular trauma;
(iv) Phacogenic glaucoma;
(v) Phacogenic uveitis;
(vi) Phacoanaphylactic endopthalmitis; or
(vii) Increased ocular pressure in a person who is blind
and is experiencing ocular pain.
(2) The department covers strabismus surgery as follows:
(a) For clients seventeen years of age and younger. The
provider must clearly document the need in the client's
record. The department does not require authorization for
clients seventeen years of age and younger; and
(b) For clients eighteen years of age and older, when the
clinical criteria are met. To receive payment, providers must
follow the expedited prior authorization process. The
clinical criteria are:
(i) The client has double vision; and
(ii) The surgery is not being performed for cosmetic
reasons.
(3) The department covers blepharoplasty or
blepharoptosis surgery when all of the clinical criteria are
met. To receive payment, providers must follow the
department's expedited prior authorization process. The
clinical criteria are:
(a) The client's excess upper eyelid skin is blocking the
superior visual field; and
(b) The blocked vision is within ten degrees of central
fixation using a central visual field test.
[Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. 08-14-052, § 388-544-0550, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and
42 C.F.R. 440.120 and 440.225. 05-13-038, § 388-544-0550,
filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. 01-01-010, §
388-544-0550, filed 12/6/00, effective 1/6/01.]