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Florida Medicaid’s Covered Services and HCBS Waivers

Visual Care Services

Medicaid reimburses for visual care services to provide eye examinations, diagnosis, treatment, and management related to ocular and adnexal pathology. 

Medicaid reimburses for visual care services including:

  • Blepharoplasty when the drooping or sagging of the eyelid(s) interferes with the recipient’s vision
  • Up to four computerized corneal topography per year
  • Up to four intravitreal implants per year
  • Lacrimal punctum plugs
  • One initial consultation visit per year
  • Pathology and laboratory services (the laboratory must hold a Clinical Laboratory Improvement Amendments license)
  • Special ophthalmological services when performed in addition to a general ophthalmological, or evaluation and management visit
  • Up to 12 temporary lacrimal punctum plugs per year when a more permanent conservative treatment will cause discomfort
  • Up to two evaluation and management visits per month
  • Up to two refractions every 365 days
  • Visual examination services performed when there is a reported vision problem, illness, disease, or injury

This service is one of the minimum covered services for all Managed Medical Assistance plans serving Medicaid enrollees.

Eligibility

Florida Medicaid recipients requiring medically necessary visual care services.

Resource Information

Information on Medicaid health plans and services is available on the Statewide Medicaid Managed Care webpage.

The Florida Medicaid coverage policies, fee schedules, and Rule are available on the Agency Website.