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Blue Choice

South Carolina Healthy Connections

Vision Services

Our member’s vision is important to BlueChoice HealthPlan Medicaid. We work with Vision Service Plan (VSP)* to offer our members specific vision benefits and services.

Select the + symbol to expand each section.

  • BlueChoice HealthPlan Medicaid vision benefits through VSP include:
    • Preventive services for our newborn members through the month of member’s 21st birthday:
      • Children’s preventive vision screenings:
        • Well-baby, well-child and well-teen health care checkup to detect visual impairments or eye conditions that could lead to vision loss
      • One eye exam, one pair of eyeglasses (frames and lenses) and related fitting every 12 months
    • Routine services for our members 19 years of age and older:
      • Only medically necessary services will be covered for members 19 years of age and older.
      • There is a $3.30 copay for members 19 to 21 years of age.

    Adult members who are diagnosed with a vision impairment need prior authorization and approval from VSP to receive vision services.

    To learn more about medically necessary vision services, search our medical policies and:

    • Select Medical Policies and Utilization Management (UM) Guidelines.
    • Enter Vision in the search field.
  • BlueChoice HealthPlan Medicaid prior authorization and claims submissions through VSP:
    • For prior authorization and information for BlueChoice HealthPlan Medicaid members, please call VSP at 800-615-1883.
    • We cover vision benefits only when a VSP network provider facilitates services.
    • Submit claims directly to VSP for these services: 

    Type of service  

     

    Code

      

    Exams and office visits 92002, 92004, 92012, 92014, 92015
    Evaluation and management services 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245
    Urgent/emergency care 99050, 99051, 99056, 99058
    Special ophthalmological services 76510, 76511, 76512, 76513, 76514, 76516, 76519, 76529, 92020, 92025, 92060, 92070, 92081, 92082, 92083, 92100, 92120, 92130, 92135, 92136, 92140, 92225, 92226, 92230, 92235, 92250, 92260, 92265, 92270, 92275, 92283, 92284, 92285, 92286, 92287, 95930
    Eye and ocular adnexa services 65205, 65210, 65220, 65222, 65430, 65435, 67820, 67840, 67938, 68020, 68040, 68761, 68801, 68810, 68815, 68840

    • Log on to the VSP website (www.Eyefinity.com) for these services:
      • Review a full listing of codes and descriptions for all services billable to VSP and additional resources for in-network VSP providers:
          1. Log in at www.Eyefinity.com.
          2. Select the VSP Online tab.
          3. Select Manuals.
          4. Select Medicaid.
          5. Select South Carolina to view the VSP Provider Manual.
            1. Choose Professional Fee Services for Routine Services to view procedure codes and diagnosis codes.
            2. Choose Submit Claims/Billing Reimbursement to view procedure codes for the CMS-1500 form and for instructions on electronic submission.
    • Submit electronic claims using electronic data interchange or submit paper claims to this address:
      VSP Vision Care
      P.O. Box 385020
      Birmingham, AL 35238-5020
    • VSP general correspondence mailing address:
      Vision Service Plan
      3333 Quality Drive
      Rancho Cordova, CA 95670

For provider information about VSP vision benefits, fee schedule, coverage policies, claims submissions and prior authorizations:

  • Call VSP Provider Services at 800-615-1883 for all questions Monday to Friday from 5 a.m. to 8 p.m. PT, Saturday from 7 a.m. to 8 p.m. PT or Sunday from 7 a.m. to 7 p.m. PT.

For member information about vision benefits, claims submissions and medically necessary vision services, call the BlueChoice HealthPlan Medicaid Provider Customer Care Center at 866-757-8286 Monday to Friday, 9 a.m. to 6 p.m. ET.

*Vision Service Plan is an independent company that provides vision benefits on behalf of BlueChoice HealthPlan Medicaid. Links on this site lead to an independent site. That company is solely responsible for the contents and privacy policies on its site.