Medically Necessary Optical Hardware

This policy covers medically necessary optical hardware — including bandage contact lenses, specialty spectacle lenses and coatings (polycarbonate, high‑index, tint/UV), rigid contact lenses, and optical prisms — when used to treat specified ocular conditions. It applies to patients with corneal disease or trauma (e.g., noninfectious keratitis, recurrent corneal erosion, post‑transplant), refractory dry eye, keratoconus, albinism or congenital aphakia, high refractive error or monocular vision (especially children), neuromuscular disorders requiring impact‑resistant lenses, and strabismus/diplopia, but coverage is limited to items that are a covered benefit and is subject to state‑specific rules (e.g., Texas diopter thresholds for polycarbonate lenses), documentation and retrospective review requirements, and fee‑schedule/manual pricing limitations.

"Bandage contact lenses for noninfectious keratitis or corneal ulceration"