Low Vision Services

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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.

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.

Download the Low Vision Fee Schedule (Excel)