A refraction determines your prescription for glasses-or part of your prescription
for contact lenses.
Why do I have to pay for it?
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. CMS, directly under the control of the US Congress, has determined that this is a "noncovered" service. This means you have to pay for that portion of the eye exam.
Further, CMS has declared that if we don't charge you extra for this service, we could receive various forms of punishment.
What does it do?
This determines your need for lenses to correct your refractive error, also referred to as your refraction, or your eye glass prescription. This is the part of the exam where the doctor, or other staff member flips various lenses inside the phoropter and asks the question like "Better 1 or Better 2?". We keep asking these questions until we have helped you achieve the best possible vision.
Is this new?
Refraction (CPT code 92015) has been a "non-covered" service since Medicare was created in 1965. Since about 2007, Medicare has been enforcing the policy of requiring eye doctors to charge separately for refractions. 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.
Can I decline the refraction?
Yes. Please advise the front desk and technician before your exam begins.
However, the doctor will be unable to provide you a prescription for glasses or
contact lenses if you decline.
