Eye Care Coding Reference
CPT 92015 refraction.
What counts as a billable refraction, why Medicare never covers it, how ABNs and the GY and GX modifiers apply, and how refraction is billed with 92004, 92014 and E/M visits. Last reviewed October 2026.
In one paragraph
The refraction code Medicare excludes.
CPT 92015 reports measuring a patient's refractive error to determine the lens prescription. It is a separate service from the eye exam codes 92002 to 92014 and the E/M codes, so it can appear on the same claim as an exam. Original Medicare excludes refraction by statute, for any reason it is done, so the patient or a vision plan usually pays for it. Because the exclusion is statutory, Medicare does not require an ABN, and many practices add modifier GY when they send the line to Medicare to get a denial for secondary insurance. Descriptions on this page are Vision Rescue summaries, not the official CPT descriptor.
92015 at a glance
- Original Medicare: never covered, by statute
- ABN: not required for Medicare, often given voluntarily
- Common Medicare modifier: GY
- Billed with: 92004, 92014, 92002, 92012 or E/M codes
- Vision plans: often bundled into the routine exam
- Medicare Advantage: depends on the plan's benefits
What counts as a refraction.
A refraction measures how the eye focuses light and determines the lenses needed to correct it. CPT gave refraction its own code in 1993, and the eye exam and E/M codes do not include it.
Commonly treated as a complete refraction
- Subjective refraction refined with the patient's responses
- Retinoscopy for young children or patients who cannot respond
- Cycloplegic refraction when indicated
- A result the doctor reviews and records, usually with a lens prescription
Commonly not charged as 92015
- An autorefraction the doctor never refines
- Reading the patient's current glasses only
- A pinhole acuity check
Coding columns describe a billable refraction as a complete one, usually with a prescription issued, and note that a prescription can be clinically withheld, for example when a diabetic patient's refraction is changing quickly. Check the payer's policy on whether a written prescription is expected.
Why Medicare does not cover refraction.
Section 1862(a)(7) of the Social Security Act excludes routine eye exams and refractions. The Medicare Benefit Policy Manual, Chapter 16, section 90, says refractions are excluded whoever performs them and for whatever purpose.
- The exclusion applies even when the exam is for an eye disease, such as cataract or glaucoma
- It applies to refractions after cataract surgery as well
- Medicare never bundles the refraction into the exam payment
- The medical exam on the same day can still be covered when it is medically necessary
- Practices may collect the refraction fee at the time of service
Medicare does not accept the HCPCS routine exam codes S0620 and S0621, which include refraction. Some coding columns recommend listing 92015 on Medicare claims anyway so the patient's notice shows it as a non-covered service.
ABNs and modifiers for refraction.
An ABN is required when a service could be denied as not reasonable and necessary. Refraction is never a Medicare benefit, so the notice is optional.
| Item | How it applies to refraction |
|---|---|
| ABN | Not required for a statutorily excluded service; many practices give one voluntarily so the patient knows they will pay |
| GY | Marks a line as statutorily excluded or not a Medicare benefit; commonly used on 92015 to get a denial for secondary insurance |
| GX | Shows a voluntary ABN was given for a non-covered service; Medicare contractors say it may be used together with GY |
| GA | Shows a required ABN is on file for a service expected to be denied as not reasonable and necessary; not the usual fit for refraction |
| Medicare Advantage | Plans set their own rules; coverage should be confirmed before the service so the patient knows their cost |
Sending 92015 to Original Medicare is optional unless the patient asks for a denial for secondary coverage. If GY causes problems with a secondary payer, some coding columns suggest billing the line without the modifier and forwarding Medicare's denial. Confirm the approach with your Medicare contractor.
Billing 92015 with an exam.
Refraction is separate from every exam code, so it can be reported on the same day as the visit.
| Same-day visit | Refraction status |
|---|---|
| 92014 comprehensive, established | Reported separately as 92015 |
| 92004 comprehensive, new | Reported separately as 92015 |
| 92012 or 92002 intermediate | Reported separately as 92015 |
| E/M office visit, such as 99214 | Reported separately as 92015 |
| S0620 or S0621 routine exam | Already included in the routine exam code |
Medicare does not bundle refraction into the eye exam or E/M payment. Vision plans, some commercial plans and some Medicaid programs fold refraction into the exam payment instead, so whether it is listed separately depends on each payer's published policy.
Vision plans, commercial plans and Medicaid.
Where refraction is often paid
- Vision plans, as part of a routine exam benefit
- Some Medicare Advantage plans with a routine eye exam benefit
- Some state Medicaid programs, under their own rules
- The patient directly, when no plan covers it
What to check with each plan
- Whether refraction is bundled into the exam or billed on its own line
- Whether the plan expects 92004, 92014, S0620 or S0621 for the routine exam
- How often a routine exam with refraction is covered, often every 12 or 24 months
- Whether the contract limits what the patient can be charged
The code itself did not change, and Original Medicare still does not cover refraction. Medicare's 2026 fee schedule applied a 2.5 percent efficiency adjustment to many non-time-based services. The eye exam codes were reported as exempt, but 92015 is not one of them, so check the final rule's exemption list if you use Medicare's values to set a self-pay fee.
From Vision Rescue Pro
Supplies for refraction and exam lanes.
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Questions about CPT 92015
What is CPT code 92015?
It is the code for a refraction, the measurement of a patient's refractive error to determine the lens prescription. It is separate from the eye exam and E/M codes.
Is 92015 covered by Medicare?
No. Original Medicare excludes refraction by statute, whoever performs it and for whatever reason, including after cataract surgery. Some Medicare Advantage plans cover it as an extra benefit.
Can 92014 and 92015 be billed together?
Yes. Refraction is not part of 92014 or any other exam code, so it can be listed on the same claim. Medicare will not pay it, and many vision plans include it in the exam payment instead.
Is an ABN needed for a refraction?
Medicare does not require an ABN for a statutorily excluded service like refraction. Many practices give one voluntarily so the patient understands they will pay.
What modifier is used for 92015 billed to Medicare?
Modifier GY is commonly added to show the service is statutorily excluded. When a voluntary ABN was given, Medicare contractors say GX may be added with GY.
Is refraction included in a routine eye exam?
It depends on the payer. The CPT eye exam codes do not include it, but many vision plans pay refraction as part of the routine exam, and HCPCS routine exam codes S0620 and S0621 include it.
Sources
Medicare Benefit Policy Manual, Chapter 16, section 90; Social Security Act section 1862(a)(7); Medicare NCCI Policy Manual, Chapter 11, 2026; Noridian guidance on modifier GX; Ophthalmology Management coding columns on refraction; Optometry and Ophthalmology Coding Alert on ABNs and modifier GY; Part B Insider on modifier GY for never-covered services; AAO practice management Q&A on billing routine exams to vision plans; Primary Care Optometry News on billing refraction separately; Blue Cross Blue Shield of Rhode Island ophthalmology exam policy; CMS CY 2026 Physician Fee Schedule final rule fact sheet; AOA statement on the 2026 fee schedule; Review of Ophthalmology 2026 coding update.
Notes and disclosures
CPT is a registered trademark of the American Medical Association. Descriptions here are Vision Rescue summaries, not official CPT descriptors. This page is general information for eye care professionals and billing staff, not legal, billing or coding advice. Payer rules vary; verify codes, modifiers and coverage with the current official code sets, your Medicare contractor and the patient's plan. Questions: providers@visionrescue.com or 1-855-692-8024.
Refract, prescribe, then follow through.
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