MedicaidBilling CodesHigh impact
KMAP BULLETIN: Vision Services – “New Patient” Coding Guidelines
Kansas Medicaid (KanCare)·KS · Ophthalmology, Optometry, Family Medicine +1 more·Coding
Effective date
Jun 1, 2025
We identified it
Jun 21, 2026
Summary
Starting June 1, 2025, KMAP will limit new patient vision evaluation codes 92002 and 92004 to once per three-year period across all providers within the same group practice, regardless of specialty. Any vision services within three years must be billed as established patient visits.
Action Required
Before June 1, 2025: Billing team must update system to track new patient vision codes 92002 and 92004 by provider group NPI to enforce three-year limitation. Train staff to verify previous vision encounters across all providers in the group (physicians, optometrists, APRNs, PAs) before billing as new patient. Update encounter forms and billing software to default to established patient codes if any vision service occurred within three years. Claims will be denied if new patient codes are incorrectly used within the three-year period.