Attention Vision Providers, Regarding Refractions

February 19, 2013

Attention Vision Providers, Regarding Refractions The MaineCare Benefits Manual, Chapter II- Section 75 states the comprehensive eye examination includes a diagnostic history, visual acuity determination, testing for refraction, muscle balance and accommodative function, ophthalmoscopy and biomicroscopy.

In most cases, you cannot bill MaineCare for a refraction test separately from the comprehensive eye exam.

When you can bill MaineCare for the refraction test separately:

  1. The only appropriate time to bill MaineCare for the refraction test separately from the comprehensive exam is when Medicare applies a portion of the comprehensive eye exam to the Medicare deductible and pays the other portion. In this case, MaineCare can allow a separate charge for the refraction test.

When you cannot bill MaineCare for the refraction test separately:

  1. If Medicare applies the total allowed for the comprehensive eye exam to the patient’s Medicare deductible, you may bill MaineCare for the comprehensive eye exam only. Since that payment is made according to MaineCare’s definition of a comprehensive eye exam which includes the refraction test, the refraction test cannot be billed separately.

  2. If the patient does not have Medicare, the refraction test cannot be billed separately to MaineCare because the comprehensive eye exam includes a refraction test.