92015 CPT Code

92015 CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

92015 CPT code bills for service when the physician performs a determination of refractive state. It determines the vision using an eye chart and whether glasses or contact lenses are needed.

92015 CPT Code Description

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.

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 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 performs a determination of refractive state. It determines the vision using an eye chart and whether glasses or contact lenses are needed.

cpt code 92015

92015 CPT Code 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.

92015 CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.

The following are ICD category 10 Payable Dx codes and report the specified level of dx code accordingly:

H44.2A1, H44.2A2, H44.2A3, H44.2A9, H44.2B1, H44.2B2, H44.2B3, H44.2B9, H44.2C1, H44.2C2, H44.2C3, H44.2C9, H44.2D1, H44.2D2, H44.2D3, H44.2D9, H44.2E1, H44.2E2, H44.2E3, H44.2E9, and H52.00.

H52.03, H52.219, H52.221, H52.222, H52.223, H52.01, H52.02, , H52.11, H52.12, H52.13, H52.201, H52.202, , H52.212, H52.213, H52.229, H52.31, H52.32, H52.4 and H52.511, H52.203, H52.209, and H52.211, and H52.10.

H52.523, H52.512, H52.513, H52.519, H52.521, H52.522 , H52.529, H52.531, H52.532, H52.533, H52.539, H52.6, and H52.7.

H53.021, H53.022, H53.023, H53.029, H53.041, H53.042, H53.043, H53.049, H53.10, H53.11, H53.16, H53.19, H53.2, H53.30, H53.31, H53.32, H53.33, H53.34, H53.40, Z01.00, Z01.01, Z01.020, and  Z01.021.

Evaluation and management CPT codes (99202-99499) bill separately when performs in conjunction with CPT 92015.

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 (CPT 99173-99174 [99177]), performs in combination with 92015 CPT code, it is appropriate to report CPT 92015 separately.

CPT 92015 includes Lens prescription 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 (CPT 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 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 CPT 99173-99174 or 99177

92015 CPT Code Modifiers

The following are the list modifiers applicable with 92015 CPT code:

22, 23, 47, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS.

Modifier 76 is applicable with CPT 92015 when a similar service performs by the Same Physician on the same service date.

Modifier 76 is applicable with CPT 92015 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT 92015 when a Distinct service performs by the physician and bundled with another procedure on the same date.

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 92015  when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure.

Modifier 22 applies to CPT 92015  when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with 92015 CPT code when general or local anesthesia administers by the physician and routinely does not require during the procedure.

Modifier 52 applies when the physician does not complete the service terminates due to unavoidable circumstances.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 92015 must apply the GA modifier to that service.

92015 CPT Code Examples

The following are the examples when 92015 CPT code bills:

Example 1

A sixty-six-year-old male with no past medical history now presents to the hospital outpatient setting for blurry vision and ocular pain. The patient lays down 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 scheduled an appointment for next week. It helps to clear the visibility of the patient.

The Refractive state shows that patient has myopia, and the physician prescribes ocular glasses to the patient.

Example 2

A 70 y/o male with no past medical history presents to the hospital outpatient setting because of bilateral ocular pain. The patient was with poor visibility and had a 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 scheduled an appointment for next week. It helps to clear the visibility of the patient.

The Refractive state shows that patient has retinitis pigmentosa, and the physician prescribes ocular glasses to the patient.

Example 3

An 80-year-old female presents to the office for traumatic injury of the right eye. she has poor visibility, pain in the right eye, and headache. She did not take any medication for the pain. He restricts 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 that patient has retinal vessel occlusion, and the physician prescribes ocular glasses to the patient.

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 any 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 scheduled an appointment for next week. It helps to clear the visibility of the patient.

The Refractive state shows that patient has Astigmatism, and the physician prescribes ocular glasses to the patient.

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 any 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 scheduled an appointment for next week. It helps to clear the visibility of the patient.

The Refractive state shows that patient has Presbyopia, and the physician prescribes ocular glasses to the patient.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *