Optometry Billing FAQs

FAQs from Optometry practices across the country answered by Applied Medical System’s expert Optometry Billing Specialists.

Q: Can I bill for retinal photography even if there is no medical diagnosis?

A: Retinal photography or fundus photo billing (CPT 92250) can be tricky. Although optometrists understand the value of a routine screening with a retinal camera, most payers will not pay unless there is a documented medical condition that was notated in the record before the test was run. Running a screening and finding retinopathy is still considered a screening.  The best way to handle this is to think of retinal screening and retinal diagnostic imaging as two different services. Upon check in, the front desk staff should explain to the patient the value of a retinal screening even if there is no history of retinopathy. It is useful to have a form that briefly explains this. The patient can then choose to opt in to the screening and pay the private payer price (since there is no insurance price) or opt out and pay nothing. When charging for a screening, use a code other than 92250 (make one up for your system) so that you can prove to any auditors that you are not providing screening services at diagnostic prices.

Q: Is a refraction considered included in a comprehensive exam? 

A: Good question. Although a refraction is considered a very important part of any eye exam from a provider’s point of view, it is NOT included in the CPT description of a comprehensive exam. Refractions are billed with their own CPT code, 92015, and this code is not covered by Medicare or most other medical insurance payers. Front desk staff should make Medicare patients aware of this up front and collect accordingly.

Q: So can I do a refraction on my Medicare patients and just not charge them for it? 

A: You sure can- as long as you don’t charge ANY of your patients for a refraction. Medicare is very strict about having a single set of billing practices applied to all insurance companies. It is recommended to collect a refraction fee on all patients for whom this service is performed and not paid by the insurance company.

Have an Optometry Billing Question? Submit it to our Experts.