refraction

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Humana Medicare patient comes in for a glacoma check and has a refraction. I know Mecicare does not cover a refraction so I collect from patient. patients husband calls conplaining and wants it billed do I bill it or not since I know it will be denied?
 

tcoleman6

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Have the member sign an ABN, submit claim with appropriate modifier, and when it's denied you can then bill the patient. Medicare website will have a form you can print and also should have the submitting instructions.
 

vpcats

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I hope I'm not too late but: Refractions are statutorily non-covered services by Medicare and do not require any ABN. IF you wanted to give one to a patient with traditional, conventional Medicare Part B coverage, you could and attach a GY modifier to the 92015 code. That tells Medicare that you informed the patient about the service being self pay and Medicare will automatically deny the claim.

HOWEVER, as the OP said that this was a Humana Medicare patient, to me that means it's HMO Medicare aged patient and not traditional, conventional Medicare. They have different guidelines - namely the HMO's policies. The patient probably has a optometric network they have to go to for routine exams including refractions, and it's covered by the plan.

If you did a real refraction and this is a HMO patient, I suggest you just write off the charge and find out when you can and cannot bill depending on actual coverage.
 
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