The term “internal body organ” includes the lens of an eye. Prostheses replacing the lens of an eye include post-surgical
lenses customarily used during convalescence from eye surgery in which the lens of
the eye was removed. Permanent lenses are also covered when required by an individual
lacking the organic lens of the eye because of surgical removal or congenital absence.
Payment may be made for one of the following combinations of prosthetic lens to restore
essentially the vision provided by the crystalline lens of the eye:
prosthetic bifocal lenses in frames; or
prosthetic lenses in frames for far vision, and prosthetic lenses in frames for near
when a prosthetic contact lens (es) for far vision is proscribed (including cases
of binocular and monocular aphakia) payment can be made for the contact lens (es)
and prosthetic lenses in frames for near vision to be worn at the same time as the
contact lens (es); and prosthetic lenses in frames to be worn when the contacts have
Payment cannot be made for cataract sunglasses obtained in addition to the regular
(untinted) prosthetic lenses.
Program payment may be made for the hydrophilic soft contact lens, Soflens (polymacon)
produced by Bausch and Lomb, Inc. or, effective with services furnished on or after
April 30, 1974, for Hydrocurve (hefilcon A) soft contact lens produced by Soft Lenses,
Inc. when prescribed as a prosthetic lens for an aphakic patient.
Coverage also extends to certain types of implanted prosthetic lenses (pseudophakoi)
and the services necessary for implantation.