Take a Closer Look at TRICARE Eyeglass Coverage

TRICARE policy is very specific about eyeglass coverage for TRICARE beneficiaries – it’s a very limited benefit. According to TRICARE Policy Manual, Chapter 7, Section 6.2, eyeglasses are only cost-shared for the following condition:

• Eyeglasses that perform the function of the human lens, lost as the result of intraocular surgery or ocular injury or congenital absence. When there is a prescription change still related to the qualifying eye condition, a new set may be cost-shared.

Coverage for eyeglasses is excluded:

• when the prescription remains unchanged
• for replacement of eyeglasses that are lost or have deteriorated
• for eyeglasses that have become unusable due to physical growth
• for adjustments, cleaning, or repairs (CPT procedure codes 92340-92371)

If eyeglasses are approved for payment, they will be reimbursed under Durable Medical Equipment Regional Carrier (DMERC) pricing guidelines. TriWest follows the Centers for Medicare and Medicaid Services (CMS) DMERC price schedules. For DMERC rates, TRICARE West Region providers in Colorado , New Mexico and Texas may refer to the Medicare Region C payer for reimbursement information at www.palmettogba.com. Providers in all other TRICARE West Region states may refer to the Medicare Region D payer at www.noridianmedicare.com.

If you have questions regarding TRICARE eyeglass benefits, refer to the TRICARE Policy Manual at www.tricare.mil. For further information, go to www.triwest.com or call 1-888-TRIWEST (888-874-9378).