When billing for ophthalmology services, one commonly used code that’s often misunderstood is the refraction CPT code. While it may seem routine, using it incorrectly or omitting it can lead to claim denials and patient confusion. Let’s break down what this code is, how it should be applied, and what your ophthalmology practice can do to stay compliant and profitable.
The Current Procedural Terminology (CPT) code 92015 is designated for:
92015 Determination of refractive state.
This service is commonly performed during routine eye exams to determine if corrective lenses (glasses or contact lenses) are needed. However, it’s critical to note that Medicare and many commercial insurance providers don’t cover this code, as it is classified as a non-medically necessary or routine service.
Use CPT 92015 when:
This code should not be billed with a medical eye exam (CPT 92002–92014) unless it’s properly documented and the patient is informed it may not be covered. To avoid bundling issues, clearly separate this service and get written consent for out-of-pocket charges when appropriate.
Using 92015 improperly can lead to denials or patient dissatisfaction. This is where a partner like EZ Settle Solutions becomes invaluable. With our expertise in ophthalmology billing, we help practices minimize claim denials and improve reimbursement through accurate coding and proactive communication. If your eye care practice is struggling with billing accuracy, check out our ophthalmology medical billing services to streamline operations and increase revenue.
Proper use of CPT codes like 92015 is only one piece of the puzzle. Practices that succeed long-term focus on overall revenue integrity and denial prevention. Learn more about how we approach this in our article on revenue cycle management in medical billing. And if you’re unsure how your current process measures up, you can request a demo to see how EZSettle Solutions can help you reduce errors and maximize collections.
For deeper guidance on refraction billing and ophthalmic coding practices, refer to this official CPT coding resource from the American Academy of Ophthalmology.
While CPT code 92015 for refraction might seem like a simple code, its implications for reimbursement are significant. Ophthalmology practices need to handle this carefully to ensure both compliance and revenue retention. With the right documentation, patient communication, and billing support, you can minimize the risk of denials and maintain financial health. Contact EZ Settle Solutions today to see how we can elevate your billing workflow.
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