The Vision Care Manual contains the regulations, administrative and billing instructions, and service codes for optometrists, opticians, ocularists, and ophthalmologists (only with respect to the dispensing of ophthalmic materials. (All other vision care services provided by ophthalmologists must by in compliance with the Physician Regulations.) The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. See 101 CMR 315.00.
MassHealth issues transmittal letters to update any part of the provider manual. MassHealth issues provider bulletins to communicate information that is not contained in the provider manual.
Each part of the Vision Care Manual is listed below from beginning to end. You can print each part separately (or any individual pages) or print all parts for a complete manual.
Table of Contents
- Table of contents pages i, ii, ii-a, and iii appear at the beginning of Subchapter 1 below.
- Table of contents page iv appears at the beginning of Subchapter 4 below.
- Table of contents page v (PDF)
- Table of contents page vi (PDF)
Subchapters 1 through 3: Administrative and Billing Regulations
- Administrative and Billing Regulations (apply to all providers) (PDF) file size 1MB file size 1MB
Subchapter 5: Administrative and Billing Instructions
For instructions for electronic billing, refer to the MassHealth Companion Guides. For instructions for billing MassHealth using paper claim forms refer to MassHealth Billing Guides for Paper Claim Submitters.
The Administrative and Billing Instructions are divided into seven parts.
- Part 1. Eligibility (PDF)
- Part 2. Prior Authorization (PDF)
- Part 3. Billing MassHealth (PDF)
- Part 4. Required Forms and Documentation (PDF)
- Part 5. Claim Status and Payment (PDF)
- Part 6. Claim Status and Correction (PDF)
- Part 7. Other Insurance (PDF)
This information is provided by MassHealth.