HI 00620.110 Routine Services and Appliances

Routine physical checkups; eyeglasses, and eye examinations for the purpose of prescribing, fitting, or changing eyeglasses (see HI 00620.200) hearing aids and examinations for hearing aids; and immunizations are not covered.

Routine physical checkups include examinations performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury, and examinations required by third parties such as insurance companies, business establishments or government agencies.

The exclusions apply to eyeglasses or contact lenses, and eye examinations for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses for refractive errors. The exclusions do not apply to services performed in conjunction with an eye disease, as glaucoma or cataracts, or to postsurgical prosthetic lenses which are customarily used during convalescence from eye surgery in which the lens of the eye was removed, or to permanent prothetic lenses required by an individual lacking the organic lens of the eye, whether by surgical removal or congenital absence.

Vaccinations and inoculations are excluded as “immunizations” unless they are directly related to the treatment of an injury or direct exposure such as antirabies treatment, tetanus antitoxin or booster vaccine botulin antitoxin, antivenin, or immune globulin. See HI 00610.306 regarding the coverage of pneumococcal vaccine and its administration.


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http://policy.ssa.gov/poms.nsf/lnx/0600620110
HI 00620.110 - Routine Services and Appliances - 09/15/1989
Batch run: 01/27/2009
Rev:09/15/1989