# Deb Drew CPC



## debdrew (Jun 25, 2008)

Hello, I code for an ophthalmologist & he was inquiring about a Medicare coding rule that stated that when a physician is seeing a Medicare pt for a general yearly eye exam that is requiring a script for glasses that the ophthalmologist has to charge for an ophthalmic exam ( New pt 92002 & 92004 or Est pt 92012 & 92014 ) with 25 modifier & bill for the refraction ( 92015 ). I have been searching for this rule & can't find anything. Can someone please help me? Thanks!


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## Kris Cuddy (Jun 26, 2008)

Deb,

I'm not sure who your carrier is, but mine is WPS Part B. In their website, they've got a policy and a companion article. I've included links to both of those.

http://www.wpsmedicare.com/part_b/policy/ophth003.pdf

http://www.wpsmedicare.com/part_b/policy/ophth003_billing.pdf

Hope this helps!

Kris


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## thompsonsyl (Jun 27, 2008)

Hi,

I also work for an ophthalmologist.  A "routine eye exam" (a refraction) is on the list of Exclusions, meaning not a Medicare benefit.  You can find this service alongside other "exclusions", such as hearing aids.  If you bill it to Medicare, it's only for the denial.  Also, since it is an "exclusion", an ABN is not required.  The patient is responsible for this service if it is done.

Hope this helps!


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