No copay benefit for diabetes retinal exam and HbA1c testing
This policy governs the waiver of member copayments for annual dilated retinal exams (with dilation documented by code 2022F) and HbA1c testing for Medicare Advantage members diagnosed with diabetes; it specifies applicability and plan exceptions.
No copay benefit for diabetes retinal exam and HbA1c testing effective 1/1/2017.
Some group-sponsored plans require a member copayment or coinsurance for these services.
No Copay Benefit Coverage Criteria
No copay benefit criteria
Covered when ALL of the following are met:
ALL of the following
- Sponsored Medicare Advantage members and individual Medicare Advantage members diagnosed with diabetes are eligible for an annual dilated retinal exam and HbA1c testing with no out-of-pocket cost.
- The annual retinal exam claim must include a line for measurement code 2022F to report the use of dilation during the exam for no copay to apply.
- Not applicable to Anthem Special Needs Plans or Anthem MediBlue Coordination Plus plans; some group-sponsored plans may require a member copayment or coinsurance for these services.
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