92015 CPT Code (2023) | Description, Guidelines, Reimbursement, Modifiers & Examples
92015 CPT code bills for service when the physician determines refractive state. It determines the vision using an eye chart and whether glasses or contact lenses are needed.
Description Of The 92015 CPT Code
The physician determines whether the patient needs a prescription for eyeglasses or contact lenses. It evaluates by evaluating the effectiveness of a series of lenses. The patient answers the questions to the physician after viewing the chart and determines accordingly.
The official description of CPT code 92015 is: “Determination of refractive state.”
It usually performs with a device known as a refractor. It contains a variety of lenses that are easily interchangeable and aid physicians in evaluating various combinations. The adjustment and fitting of glasses or contact lenses do not include in this service and prescription issues to the patient.
The following are reasons why physician performs the 92015 CPT code:
- Hyperopia: a condition related to farsightedness
- Myopia: a state of nearsightedness
- Presbyopia: a condition related to the lens causing trouble in vision
- Astigmatism: a condition that causes blurry vision
- To diagnose macular degeneration, which influences your sharp central vision
- To diagnose retinal vessel occlusion
- To diagnose retinitis pigmentosa
- To diagnose retinal detachment
92015 CPT code bills for service when the physician determines refractive state. It determines the vision using an eye chart and whether glasses or contact lenses are needed.
Reimbursement
A maximum of one unit can be a bill on the same service date of CPT 90686. In contrast, the two units allow when documentation supports the medical necessity of the service.
The cost and RUVS of CPT 90686 are $20.93 and 0.61652 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 90686 are $21.34 and 0.60477 when performed in the non-facility.
Billing Guidelines
92015 CPT code includes routine ophthalmoscopy; it is not appropriate to report separately.
If surgical procedures on eye/ocular adnexa (65091-68899 [66987, 66988, 67810]) perform in combination with CPT 92015, it is appropriate to report the 92015 CPT code separately.
If general ophthalmological services perform in combination with CPT 92015, it is appropriate to report CPT 92015 separately.
If ocular screening, instrument-based (99173-99174 [99177]), performs in combination with the 92015 CPT code, it is appropriate to report CPT 92015 separately.
CPT 92015 includes lens prescriptions such as Absorptive factor, Axis, Impact resistance, Lens power, Prism, and Specification lens types such as Bifocal or Mono-focal.
If Ocular screening, instrument-based (99173-99174 [99177])) performs in combination with CPT 92015, it is appropriate to report CPT 92015 separately.
Determination of refractive states includes specification of lens type (monofocal, bifocal, other), lens power, axis, prism, absorptive factor, impact resistance, and other factors. Eye refractions are noncovered by Medicare.
To report the fitting of spectacles when the physician provides the service, see 92340–92371. For ocular screening performed by the instrument, see 99174 or 99177. Do not report 92015 with 99173-99174 or 99177
Billing Examples
Underneath you can find a couple of cases when the 92015 CPT code can be billed appropriately.
Example 1
A sixty-six-year-old male with no medical history now presents to the hospital outpatient setting for blurry vision and ocular pain. The patient lays in bed at 10 pm and begins having a gradual onset pulsating frontal and occipital headache.
He reports that the pain was very severe. His headaches are usually associated with HTN. The blood pressure shows a value of 210/100. It denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting.
The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested determining the refractive state and scheduling an appointment for next week. It helps to clear the visibility of the patient.
The Refractive state shows that the patient has myopia, and the physician prescribes ocular glasses.
Example 2
A 70 y/o male with no medical history presents to the hospital outpatient setting because of bilateral ocular pain. The patient was with poor visibility and cloudy vision. The patient had been using eye drops for the previous two weeks.
The patient denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting. A physical exam reveals erosion in bilateral eyes.
The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested determining the refractive state and scheduling an appointment for next week. It helps to clear the visibility of the patient.
The refractive state shows the patient has retinitis pigmentosa, and the physician prescribes ocular glasses.
Example 3
An 80-year-old female presents to the office with a traumatic right eye injury. She has poor visibility, pain in the right eye, and a headache. She did not take any medication for the pain. She restricts herself to home due to poor eyesight.
The patient denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting. A physical exam reveals erosion in bilateral eyes.
The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested determining the refractive state and scheduled an appointment for next week. It helps to clear the visibility of the patient.
The refractive state shows the patient has retinal vessel occlusion, and the physician prescribes ocular glasses.
Example 4
A 56-year-old male presents to the ophthalmologist with blurry vision. He complains that he is unable to see anything. The patient said that visibility is getting poorer day by day.
The patient was unable to move freely at home due to poor visibility.
The physician examined both his eyes and saw cloudiness. The patient also has frequent headaches and denies other symptoms, such as numbness, digestive and urinary bladder issues, extremity swelling, or dizziness.
The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested determining the refractive state and scheduling an appointment for next week. It helps to clear the visibility of the patient.
The refractive state shows that the patient has Astigmatism, and the physician prescribes ocular glasses.
Example 5
A seventy-seven-year-old male presents to the office with a past medical history of chronic kidney disease and diabetic retinopathy.
The patient has had ocular pain for one week. The patient was using any medication for the pain.
The patient denies other symptoms like body aches, shortness of breath, numbness, abdominal pain, and urinary bladder symptoms. The patient also has elevated Diabetes and a higher risk of vision loss. The physician consulted with an ophthalmologist about his condition.
The physician ordered an MRI and CT of the eyes and consulted with an ophthalmologist. He suggested determining the refractive state and scheduling an appointment for next week. It helps to clear the visibility of the patient.
The refractive state shows the patient has Presbyopia, and the physician prescribes ocular glasses.