Attn: Vision Providers, Regarding Refractions

May 14, 2012

The appropriate time to bill MaineCare for refractions is when a patient is eligible for both Medicare and Medicaid, and Medicare pays for the eye exam. Medicare’s definition of an eye exam does not include refractions. Therefore, MaineCare will pay for the refraction separately after Medicare. Although MaineCare’s definition of a comprehensive eye exam includes the refraction, it cannot be billed separately to MaineCare in the absence of Medicare.

If Medicare applies the total allowed for the eye exam to the patient’s Medicare deductible, you may bill MaineCare for the eye exam only. Since that payment is made according to MaineCare’s definition of a comprehensive eye exam which includes the refraction, the refraction cannot be billed separately. If Medicare applies only a portion of the eye exam to the deductible and pays the other portion, your bill to MaineCare can include a separate charge for the refraction.