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
$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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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
Validated against the FY2026 ICD-10-CM set. Pick the most specific diagnosis the chart supports; payers deny exam codes billed with a diagnosis that does not establish medical necessity.
| 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 |