How To Use CPT Code 92015

CPT 92015 refers to the determination of refractive state, a procedure performed by a provider to assess a patient’s vision and prescribe corrective lenses if necessary. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 92015 procedures.

1. What is CPT 92015?

CPT 92015 is a code used to describe the determination of refractive state, a process in which a provider evaluates a patient’s vision and prescribes corrective lenses or contact lenses if needed. This code is used by medical coders and billers to accurately document and bill for this specific service.

2. 92015 CPT code description

The official description of CPT code 92015 is: “Determination of refractive state.”

3. Procedure

The 92015 procedure involves the following steps:

1. The patient looks at a standardized vision chart, such as a Snellen chart.
2. The provider determines the patient’s refractive state by adding lenses of varying power and adjusting other settings.
3. The patient provides feedback on whether their vision is better or worse with each adjustment.
4. The process continues until the patient’s vision is corrected as close to normal (20/20) vision as possible.
5. The provider records the settings and power of lenses used in a prescription for eyeglasses or contact lenses.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 92015 services include those experiencing vision problems or those who require an updated prescription for corrective lenses. This code can be used for both new and established patients, regardless of age or the presence of other eye conditions.

5. When to use CPT code 92015

It is appropriate to bill the 92015 CPT code when a provider performs the determination of refractive state procedure to assess a patient’s vision and prescribe corrective lenses if necessary. This code can be used regardless of whether the patient receives a new prescription or not, as the work performed should be compensated.

6. Documentation requirements

To support a claim for CPT 92015, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Date of service and location where the procedure was performed.
• A detailed description of the procedure, including the steps taken and the patient’s feedback during the process.
• The final prescription, including the power of lenses and any additional settings required for optimal vision correction.
• Any relevant medical history or additional eye conditions that may impact the patient’s vision or the prescription provided.

7. Billing guidelines

When billing for CPT code 92015, it is important to note that Medicare does not cover this service. Some private payers may cover the procedure, so it is essential to verify coverage with the patient’s insurance provider. If insurance does not cover the service, the patient is responsible for payment. As a noncovered service, refractions do not require an advance beneficiary notice, but patients should be informed that refraction is not covered and they will be responsible for payment.

8. Historical information

CPT 92015 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates to the code since its addition.

9. Similar codes to CPT 92015

Five similar codes to CPT 92015 and how they differ are:

1. CPT 92002 – Limited eye exam for new patients, which focuses on a specific problem or symptom rather than a comprehensive assessment of refractive state.
2. CPT 92004 – Comprehensive eye exam for new patients, which includes a thorough evaluation of the eye and adnexa, as well as the determination of refractive state.
3. CPT 92012 – Limited eye exam for established patients, which is a follow-up exam for a specific issue or symptom.
4. CPT 92014 – Comprehensive eye exam for established patients, which includes a complete assessment of the eye and adnexa, as well as the determination of refractive state.
5. CPT 99173 – Screening test of visual acuity, which is a brief assessment of a patient’s vision without the determination of refractive state or prescription.

10. Examples

Here are 10 detailed examples of CPT code 92015 procedures:

1. A patient with blurry vision undergoes a determination of refractive state to identify the need for corrective lenses.
2. An established patient returns for an updated prescription after noticing a decline in their vision since their last visit.
3. A child receives their first determination of refractive state as part of a routine eye exam.
4. A patient with a history of cataracts undergoes a determination of refractive state following cataract surgery to update their prescription.
5. An individual experiencing headaches and eye strain undergoes a determination of refractive state to assess the need for corrective lenses.
6. A patient with diabetes receives a determination of refractive state as part of their annual eye exam to monitor for vision changes related to their condition.
7. An elderly patient undergoes a determination of refractive state to assess the need for bifocal or progressive lenses.
8. A patient with astigmatism receives a determination of refractive state to update their prescription for toric contact lenses.
9. An individual interested in LASIK surgery undergoes a determination of refractive state to assess their candidacy for the procedure.
10. A patient with a history of glaucoma receives a determination of refractive state as part of their ongoing eye care and monitoring.