Subsection 144-101-II-75.05 - NON-COVERED SERVICESMaineCare will not reimburse providers for the following:
A. Contact lenses for members' ages twenty-one (21) and over.B. Cosmetic contact lenses such as colored or tinted contact lenses and/or contact lenses for cosmetic reasons alone.C. Eyeglasses for members ages twenty-one (21) and over, except for one pair per lifetime and only for eyeglasses of power equal to or greater than 10.00 diopters.D. Provision and repair of oversize lenses, fashion frames, fashion tints or other ophthalmic supplies that serve only a cosmetic purpose.E. Tinted lenses, ultraviolet or photochromatic lenses for members ages twenty-one (21) and over whose prescription is less than 10.00 diopters.F. Covered eyeglasses or replacement parts obtained through any lab other than the Vision Care Volume Purchase Contractor except as noted in Section 75.04-4(D).G. New examinations where a MaineCare member is merely requesting that a current eyewear prescription be filled through the Vision Care Volume Purchase Contractor.H. Sample kits available to providers through the Vision Care Volume Purchase Contractor.I. MaineCare reimburses ophthalmologists performing cataract surgery a rate including both surgery and follow-up care following the surgery. If follow-up care is provided by an optometrist, that visit may not be billed additionally to MaineCare.J. MaineCare does not reimburse for UVA or UVB for polycarbonate lenses. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-75, subsec. 144-101-II-75.05