Ophthalmology and Optometry Coding Alert

If you're considering creating a refraction policy at your practice, customize the following suggested template to help develop yours.

Refraction Policy of _______________________ (name of practice)

Our eye care professionals consider refraction a vital step in diagnosing the health of your vision. During refraction, the physician evaluates whether you are experiencing any medical issues with your eyes and can determine whether you would benefit from corrective eyeglasses. The refraction service is vital to calculating the most accurate prescription to help your vision.

Medicare and most other payers do not cover refraction as part of their medical policies. If we perform refraction as part of your new eyeglass prescription determination, our policy is to charge you a $____ fee for the service. If you have a separate vision plan outside of your medical insurance, please let us know, as many vision programs will pay for refraction.

If a payer does happen to pay us for your refraction, we will reimburse you in the amount we were paid. However, our policy is to collect the $______ refraction payment up front since insurers statutorily consider this non-reimbursable.

I, ______________ (patient name), have read _________________'s (the eye care practice's) refraction policy and understand that this is considered a non-payable service by most insurers. I agree to pay the $______ cost at the time of service and accept the fact that this refraction charge is in addition to any deductible and/or coinsurance that I may owe at the visit.

_________________________ _____________________ ____________

Patient Name (Printed)                                                                                                          Patient Signature                                                                                                                 Date