Office of Children and Family Services

New York State Commission for the Blind

Low Vision Services

The Low Vision Evaluation Report (Form 1119) is used to document the results of initial and follow-up exams and to recommend the purchase of low vision devices, including a narrative explaining the need for such devices. All recommended low vision devices must reflect the appropriate code and price listed in the fee schedule. The description of the device should be as it appears on the fee schedule. Lens systems may be recommended by using more than one code, price, and description and then totaling the cost. Some items include the cost of the frame in the price.

Download the Low Vision Fee Schedule (Excel)

Guidelines for Prescribing Low Vision Devices

The following guidelines apply when providing services to individuals referred by NYSCB.

  1. The low vision (LV) device must enable the individual to perform tasks that are necessary to the achievement of the vocational goal or a functional objective, i.e. use in the classroom, reading labels, etc. The documentation on the Low Vision Evaluation Report (Form 1119) should clearly and specifically state the relationship between the functional objective of the device being recommended and the tasks that are necessary for the person to perform related to the vocational goal. Address the purpose that a particular device will fulfill and the tasks to be performed.
  2. For a more complex LV device, the individual must have the desire and ability to use it properly. When necessary, a discussion with the referring NYSCB counselor can help to assess these factors. Special consideration must be given to the usefulness of the device beyond the exam room and in the home/school/work environment. Explain how the individual will be able to use the device independently and sustain use over time.
  3. Prescribe less expensive alternatives if they are equally effective for the purpose. The device should not only improve visual acuity or field but also actually improve performance on important tasks. A slight increase in acuity or in magnification may not always result in a tangible improvement in performance. Please consider the primary function of the device and the situation in which it will be used.
  4. When there are concerns about the effectiveness (i.e. due to fluctuating vision) or cost of a device, a trial loaner must be made available before a final recommendation to purchase is made. NYSCB is aware that some manufacturers offer a return policy and this advantage should be offered to the consumer.
  5. Adaptive equipment, non-optical devices and adaptive techniques should be considered as effective alternatives to low vision devices, particularly when the increased visual functioning that may be achieved has minimal impact on the actual performance of tasks. These alternatives must be explored when appropriate. These alternatives should also be considered for individuals with fluctuating or progressive vision loss.
  6. Low vision devices will only be replaced once for eligible individuals when the devices are damaged through occurrences beyond the control of the individual or when lost. Once an individual completes the rehabilitation plan and the case is closed, the risk of loss or damage rests upon the individual.
  7. The consumer may supplement the cost of frames should they desire more fashionable or durable frames. Frames are the only items on the fee schedule that may be supplemented by the consumer.
  8. New to the fee schedule is the addition of “Sports Frames”. Sports frames are considered durable frames (i.e. titanium or flexible frames) that are prescribed because of the nature of a person’s vocational goal or use in physical education classes necessary for a degree. Additional costs for frames as a special request will not be approved.

Once an individual has achieved the vocational goal, he/she is responsible for the care and replacement of low vision devices. We do not expect that individuals will return to NYSCB only for periodic, routine replacement of low vision devices. Your understanding and cooperation are necessary to continue to have NYSCB as a resource available to many consumers with many rehabilitation needs.

Special Request Prior Approval

Any prescribed items that are not on the fee schedule require special request prior approval and a higher level of documentation. A supplemental narrative (or the attached Special Request form) to Form 1119 must include the following items.

  1. Explain why the device is necessary.
  2. Explain the purpose of the device and how it improves functioning on specific tasks that are directly and clearly related to the individual's vocational goal.
  3. Explain the reasons why lower cost devices or existing devices on the fee schedule cannot meet the client's needs.
  4. Explain how you will assure that the client will be properly trained to use the device.
  5. Provide a price quote from a verifiable source (e.g. wholesale supplier) that clearly indicates the actual cost of the item. NYSCB will usually reimburse a provider at a modest margin above actual, true wholesale cost for optical items. Reimbursement rates for special request items are subject to change and may be modified at NYSCB's discretion.

Download the Low Vision Fee Schedule (Excel)