Optometry and Ophthalmology: Determination of Refractive State

Published 05/29/2020

Medicare statutorily excludes payment for determination of refractive state, CPT Code 92015. If the patient asks you to submit a claim for denial or for secondary insurance purposes, submit CPT code 92015 with HCPCS modifier GY. (HCPCS modifier GY indicates that the service is statutorily excluded from Medicare coverage.) If the patient does not need a Medicare denial for refraction then you are not required to submit a claim for an eye refraction. An eye refraction is never covered by Medicare.

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