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Effective December 1, 2007, refraction code 92015 is no longer going to be a covered benefit when it is billed with a medical diagnosis. The Certificate of Coverage (COC) does not support Priority Health paying the refractions.
Section 6.1.A.1(d) states "one vision screening during each contract year to determine vision loss. Vision screenings do not include refractions, which are tests to determine eyeglass prescription." Our medical policy states "refractive exams for assessment of visual acuity are not covered." Priority Health's policy is consistent with that of other payers, including Medicare. This change will be effective for all products. For routine vision eye exams the refraction will be a covered service when billed with the routine eye exam code S0620 and S0621. Vision Care/Eye Exam Medical Policy
Last modified
08/14/09
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