Print | ShareCPT Code: 92015 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Refraction
Category
Special Ophthalmological Services
Description
Refraction is the part of an eye or vision exam in which the eye doctor determines your need for prescription glasses.
This Medicare carrier does not have a local coverage determination (LCD) for refraction. The policy presented serves as a sample and it is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
Under construction.
Refraction is the part of an eye or vision exam in which the eye doctor determines your need for prescription glasses. He or she refracts your vision by using a phoropter, a device that contains hundreds of combinations of lenses, to determine any possible refractive error such as nearsightedness, farsightedness, astigmatism, or presbyopia.
Medicare does not reimburse for refraction. This fee can be collected directly from the patient as long as an advanced beneficiary notice is signed by the patient and is maintained in the file.
The purpose of a refraction test is to determine if a patient needs any refractive lenses such as eyeglasses or contact lenses. Refraction can detect any of the following:
- Myopia
- Hyperopia
- Astigmatism
- Presbyopia
Refractions can be performed even if the patient has no chief complaint about their vision. Medicare does not cover refraction tests and, therefore, no diagnosis of refractive errors are required.
The medical record must be made available to Medicare upon request.
1. Report a refraction with CPT Code 92015. This is a bilateral test, therefore no modifiers are required if both eyes are examined.
2. An eye examination may be reported on the same day as a refraction if it is medically necessary.
3. A refraction requires general supervision by the optometrist/ophthalmologist.
This Medicare carrier has no utilization guidelines for refractions. It is expected that these services would be performed as indicated by current medical literature and/or current standards of ophthalmologic practice.
In the absence of specific utilization guidelines, optometrists/ophthalmologists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of ophthalmic practice.