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Refraction Charges during Cataract Post-Op Care

Jody Posted Wed 22nd of October, 2014 10:26:49 AM

Are we allowed to collect a refraction fee from patients when they are refracted for their Medicare covered eye glasses following cataract surgery? This is typically preformed around the 4-week point in the post-op period. It is our understanding that refraction is never covered or bundled under Medicare and would be the patient's responsibility in all circumstances. Any help you can offer is appreciated.

SuperCoder Answered Wed 22nd of October, 2014 11:20:51 AM

Thank you for your question.
You may bill the patient, no ABN is required.

"...Medicare won't pay for 92015 (Determination of refractive state). Some private payers might, so be sure to check with the patient's 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 for the service. As a noncovered service, refractions don't require an advance beneficiary notice, but you should inform the patient that refraction is non–covered and, as such, he will be responsible for payment."

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