CPT 92015Determination 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
Use the current payer fee schedule for this code, locality, service setting and date of service.
Rates and patient responsibility depend on the payer and service. No unsourced national average is presented here.
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
Verify CPT 92015 against official sources
Use the code set and payer policy applicable to the date of service. This educational reference is not a coverage decision or a substitute for a qualified coding review.
- CMS Physician Fee Schedule: select the year, locality and service setting before looking up payment information.
- CMS NCCI edits and manuals: check the applicable code-pair edits and modifier instructions.
- Medicare Coverage Database: find relevant coverage and documentation policies.
- AMA CPT resources: consult the current licensed code set.
A practical documentation check
- Match the documented service to the code definition.
- Confirm patient status, laterality, components and any required interpretation.
- Check coverage, edits and payer-specific requirements.
- Have the responsible clinician or billing reviewer resolve discrepancies before submission.
Editorial sources updated September 15, 2026. Published by Jelo.
Jelo’s AI scribe is an upcoming add-on from $70/month. It is being developed to assist with documentation and code suggestions; clinicians and billing staff must verify every code. It is not included in the live platform subscription.
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Worked example: billing CPT 92015
During a comprehensive exam the refraction yields a new spectacle prescription for bilateral myopia. Bill 92015 on its own claim line with H52.13; the exam itself goes on a separate line as 92004 or 92014. For Medicare, refraction is statutorily excluded, so append -GY (or -GA if an ABN was signed) and collect the refraction fee from the patient. Most vision plans reimburse 92015 under the routine exam benefit.
ICD-10 codes commonly paired with CPT 92015
Verify suggested diagnoses against the current ICD-10-CM set and the documented encounter. A listed diagnosis does not by itself establish medical necessity or payer coverage.
| ICD-10-CM | Description |
|---|---|
| H52.13 | Myopia, bilateral |
| H52.03 | Hypermetropia, bilateral |
| H52.223 | Regular astigmatism, bilateral |
| H52.4 | Presbyopia |
| H52.7 | Unspecified disorder of refraction |
| Z01.00 | Encounter for examination of eyes and vision without abnormal findings |