CPT Code 92015: Determination of Refractive State
Determination of refractive state
CPT 92015 reports the determination of refractive state (refraction). It is the measurement of a patient's refractive error to determine the corrective lens prescription. Refraction is a separately identifiable service from the eye exam and can be billed in addition to 92004, 92014, 92002, 92012, or an E/M code.
When to use CPT 92015
Use CPT 92015 when refraction is performed as part of any eye examination. Always bill it as a separate line item from the exam code.
Documentation requirements
- Manifest refraction (subjective or objective) documented
- Lens prescription recorded
- Clinical indication for refraction
Reimbursement
$30 to $50 (not covered by most medical plans, often patient-pay)
National averages only. Rates vary by locality, payer, and fee schedule. Verify with your contracted payers.
Common modifiers
- None typically required
Common denial reasons for CPT 92015
- Billed to Medicare as covered service (Medicare does NOT cover refraction)
- Vision plan denied because included in global exam fee
- Missing documentation of the refraction
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