Refraction and low vision exam questions.

Cheezum51

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Refraction, 92015, has always been a code which isn't covered by Medicare and most other medical carriers. Since it's a procedure which has it's own CPT code and is reimbursed by direct patient payment to the provider, I don't believe it should be counted as part of the time when a provider uses Time to select the E/M.

To me, as an eye doctor, the refraction is the procedure to determine what eyeglass prescription is needed to provide the best visual acuity for the patient with glasses. Once you gather that information, you then use it to determine which low vision devices help the patient meet their ADL vision goals.

Now to my question. Historically, most low vision providers tend to charge a high fee for the refraction portion of their total exam fee to also cover the effort needed to determine which low vision aids (magnifiers, telescopes, CCTV reading devices) to prescribe for these patients. Personally, I feel that the time needed to evaluate those devices is along the lines of an occupational therapy evaluation and should be included in determining the total doctor time used to select the E/M code for the overall exam.

Any input or thoughts would be appreciated. I've not been able to find any guidance on this from Medicare or other insurers.
 
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