On this page
- What Is CPT Code 92015?
- Who Pays for Refraction?
- How Is Refraction Billed to Medicare Patients?
- Is Refraction Part of the Eye Exam Code?
- Can Refraction Be Billed After Cataract Surgery?
- How Is 92015 Billed When a Secondary Plan Covers It?
- How Should Practices Tell Patients About the Refraction Fee?
- How Do Practices Collect Refraction Fees?
- Why Do Refraction Charges Go Unpaid?
Key takeaways
- Refraction is billed separately with 92015 and is never part of the eye exam code.
- Medicare excludes refraction by law, so an ABN is not required and modifier GY marks the claim when one is filed.
- Most vision plans include refraction in the routine exam benefit, though some carve it out.
- Practices that post a set refraction fee and collect it at check-in avoid most refraction write-offs.
What Is CPT Code 92015?
CPT code 92015 is the code for determination of refractive state, the measurement an eye doctor uses to find the lens power a patient needs. It is billed on its own line, because refraction is not included in the 92 eye exam codes or the E/M codes.
Refraction is performed at most routine exams and many medical visits, usually on the same claim as an eye exam code such as 92014.
Who Pays for Refraction?
Vision plans usually pay for refraction as part of a routine exam, Medicare never pays for it, and commercial medical plans vary. The table shows how each payer type usually treats 92015.
| Payer | How 92015 is usually handled |
|---|---|
| Original Medicare | Never covered, the patient pays |
| Medicare Advantage | Some plans add a routine vision benefit that covers it |
| Vision plans such as VSP and EyeMed | Usually included in the routine exam benefit |
| Commercial medical plans | Varies, often excluded or bundled |
| Medicaid | Varies by state, often covered for children |
Because the payer changes the answer, benefits should be checked before the visit. Our eligibility verification team confirms refraction coverage for every patient.
How Is Refraction Billed to Medicare Patients?
Refraction for a Medicare patient is collected from the patient, because Medicare excludes it by law and no ABN is required. When a claim is needed, it is sent with modifier GY so Medicare issues a denial.
A claim is worth sending when the patient asks for one, or when a secondary plan pays only after a Medicare denial. Otherwise, most practices collect the refraction fee at the visit and do not bill Medicare at all.
Is Refraction Part of the Eye Exam Code?
No. Refraction is never included in the 92 eye exam codes or the E/M codes, so it is always reported on its own line with 92015. Some vision plans include refraction in a single routine exam fee, but the service is still separate in CPT.
Leaving 92015 off the claim does not make refraction free. It means the practice performed a service it was not paid for.
Can Refraction Be Billed After Cataract Surgery?
Yes. Refraction after cataract surgery is not part of the surgical global package, because Medicare never covers it, so the patient pays for it. It is usually performed at the final post-op visit to prescribe new glasses.
Medicare does cover one pair of glasses or contact lenses after cataract surgery with a lens implant, but not the refraction itself. Explaining this to patients before surgery prevents most complaints about the fee. Our cataract surgery billing team sets up these patient charges with the surgery quote.
How Is 92015 Billed When a Secondary Plan Covers It?
When a secondary plan covers refraction, bill Medicare first with 92015 and modifier GY, then send the Medicare denial to the secondary plan. The GY modifier tells Medicare the service is excluded, so the denial comes back quickly.
- Bill Medicare. Send 92015 with modifier GY.
- Receive the denial. Medicare denies the line as excluded.
- Bill the secondary. Send the claim with the Medicare denial attached.
- Bill the patient. Collect any amount the secondary plan does not pay.
Ask the secondary plan first whether it covers refraction at all. Many do not, and the patient pays the full fee.
How Should Practices Tell Patients About the Refraction Fee?
Tell patients about the refraction fee when the visit is booked, again at check-in and in writing, in plain language. Patients accept the fee far more easily when it is not a surprise.
A short line works well, for example "Medicare and most medical plans do not pay for the glasses prescription test, so there is a separate fee for it today." A voluntary written notice is not required for Medicare, but it gives the patient the price in advance and protects the practice from disputes.
How Do Practices Collect Refraction Fees?
Practices collect refraction fees reliably when the fee is set in advance, told to the patient before the exam and collected at check-in. These four steps prevent most refraction write-offs.
- Set one fee. Use the same refraction fee for every self-pay patient.
- Tell patients early. State the fee when the visit is booked and at check-in.
- Check the plan. Confirm whether the vision or medical plan covers it.
- Collect at the visit. Take the fee before the patient leaves.
Our patient billing service follows up on any refraction balance left after the visit.
Why Do Refraction Charges Go Unpaid?
Refraction charges go unpaid most often because they are billed to a payer that never covers them, or because the patient was not told about the fee. A medical claim with 92015 on it can also confuse a secondary payer.
Keeping refraction off medical claims unless a payer covers it, and collecting it as a patient charge, avoids both problems. Our vision plan billing team bills refraction to the plans that include it.