Billing for Eye Refractions

An eye refraction is one of the most basic components of most eye exams, yet from a billing standpoint, can be one of the most controversial. An eye refraction is the process of making a clinical decision for prescribing a prescription lens. A manifest refraction is an undilated test; that is, it is done without dilating drops, and allows the crystalline lens of the eye to accommodate. This allows the eye to be examined in its natural state. A manifest refraction is a very subjective test; that is, it's based on the patient’s answer of what looks best to them. A cycloplegic refraction uses cycloplegic drugs to paralyze the ciliary muscles of the eye. This temporarily stops the patient’s ability to accommodate and allows for a more precise refraction. Many cycloplegic drops also dilate the pupil, making it easier for the physician to see the back of the eye and diagnose any retinal issues.

From an insurance standpoint, eye refractions are considered part of a routine eye exam. Because refractions are normally used to determine refractive errors such as myopia, hyperopia, and astigmatism, and therefore prescribe glasses or contact lenses, many insurance companies, particularly Medicare and Medicaid, do not pay for them. It's important to convey that to patients when they are having their eye exam. Refractions are a necessary part of a routine eye exam and must be paid for out of pocket.

If you have any questions regarding your current glasses or contact lens prescription, please contact Eyecare Medical Group at 1-888-374-2020.