Type of eye exam or evaluation determines whether cost sharing applies

We’d like to clarify the difference between a complete routine eye exam, in which a cost sharing applies, and a visual acuity screening and brief vision evaluation where cost sharing is waived for children of General Motors salaried active members. (See details on age ranges at end of this article.)

Benefit policy
General Motors salaried active members and General Motors Manufacturing SubSystems are allowed one routine eye exam per calendar year under the medical benefit when reported with specified diagnosis codes and when performed by either an optometrist or ophthalmologist in an office setting or skilled nursing facility. Cost sharing is applied to the service. The procedure and diagnosis codes are listed below:

Procedure codes:
*92002, *92004, *92012, *92014, *92015, S0620, S0621

Diagnosis codes:
V72.0, V80.0, V80.2, 367.0, 367.1, 367.20, 367.21, 367.22, 367.31, 367.32, 367.4, 367.51, 367.52, 367.53, 367.81, 367.89, 367.9, 368.03

A vision acuity screening and brief vision evaluation test are a benefit for all groups** covered by plans under the Affordable Care Act. Cost sharing is waived for children of GM salaried active members when services are provided by in-network providers as follows:

*99172 - Visual acuity screening — for children under age 5

*99173 - Brief vision evaluation — for children through age 21

**This does not include Manufacturing SubSystems as they are a grandfathered group.