SEP 12, 2016
Medical Diagnosis with Refractions
Question: We find some payers cover a refraction annually with a medical diagnosis. Should our practice submit medical or vision diagnoses on refractions?
Answer: Every payer seems to have their own guidelines for refractions. When participating with a payer that allows for payment once on a refraction with a medical diagnosis, then yes, it is best to report the medical diagnosis rather than refraction. However, most payers don’t have such policies. Insurance companies that offer routine or preventive vision plans typically have an allowable for the refraction linked to routine exam diagnoses. However, payers like Medicare Part B say the refraction payment is the patient's responsibility.