# 1 Tex. Admin. Code § 354.1021: 1 TAC § 354.1021. Additional Claims Information Requirements, DIVISION 2. MEDICAID VISION CARE PROGRAM

> Texas · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1021

## Section

- **Citation:** 1 Tex. Admin. Code § 354.1021
- **Heading:** 1 TAC § 354.1021. Additional Claims Information Requirements, DIVISION 2. MEDICAID VISION CARE PROGRAM
- **Jurisdiction:** Texas
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Texas Administrative Code / Title 1 ADMINISTRATION / Part 15 TEXAS HEALTH AND HUMAN SERVICES COMMISSION / Chapter 354 MEDICAID HEALTH SERVICES / 1 TAC § 354.1021

## Text

Providers must meet the claim criteria established in the provisions
 of this division for optometric services and the provisions for participation
 in the Medicaid program established under Division 1, Medicaid Procedures
 for Providers, and Division 11, General Administration, of this subchapter.
 In addition to the claims information requirements established in
 §354.1001 of this subchapter (relating to Claim Information Requirements),
 the following information is required for claims for vision care services:
(1) name, address, and Medicaid provider identification
 number of the ordering provider, as appropriate;
(2) description of lenses and frames provided;
(3) provider's signature on the claim form, including
 degrees or credentials, verifying the diopter or axis changes required
 for the dispensing of replacement eyewear;
(4) claims for eyewear with special features must be
 accompanied by a signed form by the recipient that acknowledges his
 selection of eyewear that is beyond the specifications for eyewear
 in §354.1017 of this division (relating to Specifications for
 Eyewear). A signed patient certification satisfies this requirement
 for claims that are electronically submitted;
(5) if the claim is for replacement of prosthetic eyewear
 that was lost, stolen, or damaged beyond repair, the recipient must
 sign the claim form or, in the case of providers who electronically
 bill, a patient certification; and
(6) if the claim is for vision care services provided
 to a Medicaid recipient residing in a skilled nursing facility or
 an intermediate care facility, the claim must indicate the name of
 the physician who ordered the services and the name of the facility
 where the recipient resides as the place of service.

## Nearby sections

- [1 Tex. Admin. Code § 354.1001 1 TAC § 354.1001. Claim Information Requirements, DIVISION 1. MEDICAID PROCEDURES FOR PROVIDERS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1001.md)
- [1 Tex. Admin. Code § 354.1002 1 TAC § 354.1002. Compliance with Civil Rights Act, DIVISION 1. MEDICAID PROCEDURES FOR PROVIDERS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1002.md)
- [1 Tex. Admin. Code § 354.1003 1 TAC § 354.1003. Time Limits for Submitted Claims, DIVISION 1. MEDICAID PROCEDURES FOR PROVIDERS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1003.md)
- [1 Tex. Admin. Code § 354.1004 1 TAC § 354.1004. Retention of Records, DIVISION 1. MEDICAID PROCEDURES FOR PROVIDERS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1004.md)
- [1 Tex. Admin. Code § 354.1005 1 TAC § 354.1005. Unauthorized Charges, DIVISION 1. MEDICAID PROCEDURES FOR PROVIDERS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1005.md)
- [1 Tex. Admin. Code § 354.1015 1 TAC § 354.1015. Benefits and Limitations, DIVISION 2. MEDICAID VISION CARE PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1015.md)
- [1 Tex. Admin. Code § 354.1017 1 TAC § 354.1017. Specifications for Eyewear, DIVISION 2. MEDICAID VISION CARE PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1017.md)
- [1 Tex. Admin. Code § 354.1021 1 TAC § 354.1021. Additional Claims Information Requirements, DIVISION 2. MEDICAID VISION CARE PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1021.md)
- [1 Tex. Admin. Code § 354.1023 1 TAC § 354.1023. Optometric Services Provider, DIVISION 2. MEDICAID VISION CARE PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1023.md)
- [1 Tex. Admin. Code § 354.1025 1 TAC § 354.1025. Competitive Procurement of Vision Care Services, DIVISION 2. MEDICAID VISION CARE PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1025.md)
- [1 Tex. Admin. Code § 354.1031 1 TAC § 354.1031. General, DIVISION 3. MEDICAID HOME HEALTH SERVICES](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1031.md)
- [1 Tex. Admin. Code § 354.1033 1 TAC § 354.1033. Provider Participation Requirements, DIVISION 3. MEDICAID HOME HEALTH SERVICES](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1033.md)
- [1 Tex. Admin. Code § 354.1035 1 TAC § 354.1035. Recipient Qualifications for Home Health Services, DIVISION 3. MEDICAID HOME HEALTH SERVICES](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1035.md)
- [1 Tex. Admin. Code § 354.1037 1 TAC § 354.1037. Written Plan of Care, DIVISION 3. MEDICAID HOME HEALTH SERVICES](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1037.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C354_S354_1021. Check the current official text before relying on it. Not legal advice.