Texas Insurance Code - INS § 1451.157. Vision Plan Conduct

(1) “Extrapolation” means a mathematical process or technique used by a vision care plan in the audit of an optometrist or therapeutic optometrist to estimate audit results or findings for a larger batch or group of claims not reviewed by the plan.

(2) “Vision care plan” means a limited-scope policy, agreement, contract, or evidence of coverage that provides coverage for eye care expenses but does not provide comprehensive medical coverage.

(1) use extrapolation to complete an audit of a participating optometrist or therapeutic optometrist.  Any additional payment due to a participating optometrist or therapeutic optometrist or any refund due to the vision care plan must be based on the actual overpayment or underpayment and may not be based on an extrapolation;  or

(2) exclude an optometrist or a therapeutic optometrist as a participating practitioner in the plan if the optometrist or therapeutic optometrist satisfies the vision plan's credentialing requirements and agrees to the vision plan's contractual terms.

(1) Level I codes published by the American Medical Association;  and

(2) Level II codes published by the Centers for Medicare and Medicaid Services.