Medicare and Refractions

Clinically, refraction means determination of the eyes’ refractive error and prescribing the appropriate corrective lenses to ameliorate the defect. In patients capable of responding to choices, the task is accomplished by presenting the patient with a series of test lenses in graded powers to determine which provide the sharpest, clearest vision.

For young patients, less than 6 years of age, who cannot give a subjective reply, retinoscopy is the key to refraction. After the measurements are made, the ophthalmologist or optometrist decides on the appropriate prescription.

 

This FAQ addresses the following:

1. What is a refraction?
2. What is Medicare’s policy concerning refractions?
3. When may we charge for a refraction?
4. Is there a set or maximum amount we may charge?
5. Must we dispense an Rx for eyeglasses?
6. Must we get an Advance Beneficiary Notice of Noncoverage signed in order to collect from the beneficiary?
7. Must I include refractions on claims for Medicare beneficiaries?
8. How often may refraction be repeated?
9. Are refractions ever considered part of the office visit or eye exam?

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