Refractions determine the focusing of light rays to the back of the eye. An annual refraction during your exam is vital to determine your best potential vision.
What ARE REFRACTIONS?
Eye exams are essential to staying up-to-date on the health of your eyes. An annual refraction during your exam is vital to determine your best potential vision.
A refraction, routinely given during an eye examination, is designed to tell your doctor if you need prescription lenses or an update on your current lenses and to provide clues to medical conditions affecting your eyes.
Refractions determine the focusing of light rays to the back of the eye. This can result in reduced vision. Some refractive errors include farsightedness, nearsightedness and astigmatism.
A refraction test will determine what corrective lenses you need to achieve your optimum vision. This is the part of the exam where various lenses inside the phoropter are flipped and you are asked questions like “Better 1 or Better 2?” In addition, this provides essential medical information for the doctor in determining if there is eye disease present.
Our office fee for a refraction is $45, this fee is collected along with any co-payment, along with any co-payment your insurance plan may require. Should your plan pay for the refraction, we will reimburse you accordingly. If you have a well vision eye insurance (VSP, EyeMed) please see below.
Why to get annual vision tests
Eye and vision examinations are an important part of preventive health care because many problems related to our sight have no obvious signs or symptoms. Without preventive care, many individuals are unaware that a problem exists. Early diagnosis and treatment of eye and vision problems are important for maintaining good vision, preserving healthy eyes and preventing vision loss.
Why a refraction?
You may think that having an annual dilated eye exam would be sufficient when caring for our eyes. However, checking your vision with updated corrective lenses on a yearly basis will help your doctor detect any changes present in your ocular health. When variation occurs, it’s up to the physician to determine whether it’s due to a refractive change or another factor attributing to vision decline. A refraction not only helps your doctor determine if you need corrective lenses, but it also acts as an important tool that enables tracking of the overall health of your eyes.
Without a consistent refraction, it becomes increasingly difficult for a doctor to follow your vision changes. Noticing slight changes in your vision can be a difficult task. Having a regularly scheduled refraction is the most accurate way to track your best corrected vision. It also provides you with a record of your current glasses prescription, which is especially important if you happen to lose or break your current pair.
Routine well vision and/or medical examinations, are recommended annually to monitor eye health, as well as to review your vision needs. If you have concerns about your vision, it’s important to speak to the doctor to discuss treatment options. Early detection is crucial to prevent and treat eye diseases and conditions.
Why do I have to pay for it?
Why do I have to pay? The refraction fee covers the service of performing a refraction, not the dispensing of the prescription.
CMS, the department of the federal government that controls Medicare and Medicaid, has decided that refractions are not a payable part of an eye exam. Medicare does not cover refractions because they consider it part of a “routine” exam and Medicare doesn’t cover most “routine” procedures only health related procedures. So if you have a medical eye problem like cataracts, dry eyes or glaucoma then Medicare and most other Health Insurances will cover the Medical portion of the eye exam but not the refraction.
CMS, directly under control of the US Congress, has determined this is a “non- covered” service. That means you have to pay for that portion of the eye exam as it is NON-COVERED.
For those with vision insurance plans that we are a part of (VSP and EyeMed), please see below.
Usually medical carriers follow Medicare guideline and are opposed to including refraction in medical eye exams because they do not consider refraction necessary to keep eyes healthy. Most pathology is found during visits in which a refraction is performed. Medical insurances mandate a separate charge for the refraction to prevent practitioners from billing medical insurance for a non-covered service.
An exception to this would be if you have a valid prescription from another eye care specialist. We can use this information and do not need to recheck the refraction. Please have a copy of this available or have it sent to our office before your appointment. Our fax number is 937-553-2021.
Is this new?
Refraction (CPT code 92015) has been a “non-covered” service since Medicare was created in 1965.
As many private insurance carriers adopt the policies of the federal government, many of our contracts with private insurance carriers require us to collect the money from you, as well. Recently Medicare and insurance companies have been enforcing this policy.
Since there are many combinations of this depending on whether you have medical insurance, vision insurance, both of these, or no insurance, we cover some of the potential scenarios below.
Routine Well Vision Exams vs. Medical Exams
A routine eye exam is defined by insurance companies as an office visit for the purpose of checking vision, screening for eye disease, and/or updating eyeglass or contact lens prescriptions. Routine eye exams produce a final diagnosis, like nearsightedness, farsightedness or astigmatism.
Vision insurance plans provide coverage for routine exams, the refraction service, glasses and contact lenses. A routine eye exam is billed to your vision insurance plan. Medicare and most medical insurances do not pay for routine vision exams.
What is a medical eye exam?
A medical eye exam produces a diagnosis, like conjunctivitis, dry eye, glaucoma or cataracts, to mention a few. Depending on your policy, your medical insurance covers a medical exam, but will not pay for the exam if it is a routine eye exam. Examinations for medical eye care, assessment of an eye complaint or to follow up on an existing medical condition are billed to your medical insurance plan.
What is a refraction?
Remember a refraction is the part of an office visit that determines your eyeglass prescription. It typically involves questions like, “which is clearer – option one or option two” as different lens combinations are shown to you. Vision insurance policies generally cover both the eye exam and the refraction. Medical insurance will not cover the cost of the refraction.
What if I have a combination of medical and vision insurance?
If you have no medical problems or eye complaints, you will undergo a routine well vision check and your vision insurance will be billed. If you do not have vision insurance, we have a self-pay rate of $99 which includes the refraction.
If you have medical issues (diabetes, arthritis, etc) requiring a medical eye exam, and both medical and vision insurance, we perform these on separate days and do not coordinate the benefits on the same day because it often is denied. You will sign a paper indicating which exam you choose to have on that particular day. If you have vision insurance but no medical insurance, your vision insurance will be billed for the well vision portion of the exam and the medical testing will be out of pocket.
If you have medical insurance, but no vision plan the refraction charge will apply because it is not a covered service.