North Carolina Medicaid and North Carolina Health Choice
Salem Optical Outlet is a North Carolina Medicaid and North Carolina Health Choice eyewear provider serving all North Carolina Medicaid or North Carolina Health Choice recipients. Salem Optical Outlet does not offer eye exams but does provide a convenient location for recipients to order and receive their eyewear after they have received their routine eye exam from their provider.
This page is designed to offer general guidelines and answer the most common questions concerning visual aids. If you want further information regarding eligibility or other information on benefits please click on links provided.
Salem Optical Outlet
4310 Enterprise Drive Suite I
Winston Salem, NC 27106
Routine Eye Exams
Routine eye exams and visuals aids are not covered for adult beneficiaries (age 21 and up). Routine eye exam with refraction is limited to once per year. An early routine eye exam may be approved subject to the criteria and limitations listed in this policy. For information regarding Routine Eye Exams and Visual aids for beneficiaries under the age of 21: http://www.nchttps://dma.ncdhhs.gov/home
Medicaid Carolina ACCESS (Community Care of North Carolina) Referral Authorization Medicaid beneficiaries enrolled in Carolina ACCESS (Community Care of North Carolina) are eligible to receive optical services subject to all Medicaid guidelines, limitations, and prior approval criteria according to the eligibility categories (Regular, MPW, Family Planning Waiver, etc.). Authorization by an enrollee’s Carolina ACCESS primary care provider (PCP) is not required for routine eye exams. However, some vision services require PCP authorization.
- Service Limitations Visual aids are limited to once a year. Early visual aids may be approved subject to the criteria and limitations listed in this policy
- Beneficiary Purchase of Non-Covered Frame Medicaid and NCHC do not provide payment for non-covered frames that a beneficiary elects to purchase in lieu of a Medicaid or NCHC frame. If the beneficiary elects to purchase a frame, the beneficiary is also responsible for the lens purchase. This private transaction between the provider and the beneficiary does not negate the beneficiary’s eligibility for Medicaid or NCHC eyeglasses. Providers shall not bill Medicaid or NCHC for eyeglasses purchased by the beneficiary.
For information regarding select vision care services including visual field examination and cataract surgery: https://dma.ncdhhs.gov/home
For information regarding Eye Refractions and Office Visits for Diabetic patients: http://www.ncdhhs.gov/dma/bulletin/1100Bulletin.htm#remindereye
For an index of Bulletin articles related to Optical Services: http://www.ncdhhs.gov/dma/bulletin/optical.htm