Optometry Coding & Billing Alert

Published on Thu Jul 08, 2004 PDF

Question: Is it appropriate to bill a patient for 92015 even if the optometrist doesn't give the patient a new prescription?

Iowa Subscriber

Answer: Yes. 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 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 the service. As a non-covered service, refractions don't require an advance beneficiary notice, but you should inform the patient that refraction is noncovered and, as such, he will be responsible for payment.