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Thread: 92015

  1. #1
    Join Date
    Apr 2007

    Default 92015

    AAPC: Back to School
    Can anyone clarify this?

    medicare is not paying for the cpt 92015 but commercials are paying, medicare saying routine exam are not covered, is there any alternative code for 92015 or need to file with any specific dx.
    please let me know i have more than 800 line items in denial.

  2. #2


    Medicare does not pay for Routine Eye Exams (refractions) even with medical diagnoses in most instances. You still bill them for it but add a -GY modifier to it and it is the patient’s responsibility to pay. We always make sure the patient is aware of this before hand so there is no surprise charges for them. Until 01/01/11 Medicare did not pay for ANYTHING routine but as of the beginning of this year with the healthcare reform they now pay for a physical although I'm not sure of the limitations. Hope that helps some!

  3. #3
    Join Date
    Apr 2007

    Post 92015

    Thanks for your suggestion man. I still have some more doubt in opthalmo billing.

  4. #4
    Join Date
    Apr 2007
    Fullerton/Buena Park, CA


    If the patient has a vision plan and are eligible for an exam, you can bill the vision plan for the 92015 after you bill all the medical insurances first.

    Since the refraction is not a covered benefits with Medicare, you can also collect this from the patient.
    Jennifer DeWitte, CPC, CPC-P, CPB
    Newport Center Surgical
    Coding & Billing Department

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