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MA refraction coverage update

Effective January 1, 2023, refractions for Blue Cross and Blue Shield of Kansas (BCBSKS) Blue Medicare Advantage (MA) members are covered when submitted with an exam to BCBSKS. Recently, it was discovered claims for the refraction service were inappropriately denying as non-covered when submitted. Impacted claims are being reprocessed.

As a Medicare Advantage plan, Blue MA is able to provide coverage beyond that of original Medicare, with the determination of refractive state, one of the latest expanded benefits. Providers should be sure to include the line item and procedure code for the refraction when submitting Blue MA claims to BCBSKS. EyeMed providers should continue to submit claims for routine eye exams and hardware to EyeMed.

For additional information on benefits, contact Blue MA Provider Services at the number on the member identification card, utilize Availity, or visit https://www.bcbsks.com/providers/medicare-advantage.

If you have any questions regarding this publication, please contact your BCBSKS MA provider representative.