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Optometry Coding & Billing Alert

You Be the Expert:
Refraction Without Prescription

Question: Is it appropriate to bill a patient for 92015 even if we don’t give him a new prescription?

Iowa Subscriber

Answer: Yes. You did the work and should be paid for your time. Code the work performed, with or without prescription, just as you would an E/M service.

You probably already know that Medicare won’t pay for 92015 (Determination of refractive state). Some private payers might, so be sure to check with the patients payer so you can discuss potential payment issues with him before the procedure. If insurance won’t cover it, the patient is responsible for paying the service.

As a non-covered service, refractions don’t require an advance beneficiary notice (ABN), but you should inform the patient that refraction is non-covered and, as such, he will be responsible for payment.