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    v1.0.30
    OpenPayerBilling CodesOphthalmological Examination and Evaluation ProceduresCPT cpt-92015-refraction-vision-assessment-corrective-lenses
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    CPT 92015: Subjective Refraction for Corrective Lenses

    Commercial payers pay $26 on average nationally for this procedure.

    CPT code 92015 describes the clinical process of determining a patient’s visual acuity that is worse than 20/20 and quantifying the refractive error so that corrective lenses or contact lenses can be prescribed and produced; this service is a refraction typically performed in an outpatient clinic or optometry/ophthalmology office and involves subjective testing to establish the lens prescription.

    For related coverage guidance, see recent payer policy updates: Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping, Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping, Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mapping.

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    National Reimbursement Benchmarks

    Commercial national rates for CPT 92015 center around BUCA’s average commercial rate of $26.4, with substantial variation across major payers. Blue Cross Blue Shield shows a relatively tight middle distribution (P25 $17.8 to P75 $27.1, range $9.3) while Aetna’s interquartile spread (P25 $15.0 to P75 $35.2, range $20.2) and Cigna’s spread (P25 $20.0 to P75 $40.7, range $20.7) are much wider, indicating greater variability in negotiated allowed amounts. UnitedHealth Group sits between those extremes with a P25–P75 range of $19.4 ($20.6 to $39.9).

    Maximum and minimum extremes further highlight dispersion: Cigna posts the highest observed maximum at $77.9 and Aetna the lowest minimum at $2.2, while BUCA’s mean of $26.4 provides a midpoint reference for commercial activity. Overall, Blue Cross Blue Shield is the tightest in interquartile spread and Cigna the widest, with Aetna also showing high variability.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 57-year-old established patient presents to an ophthalmology clinic complaining of blurred distance and near vision that has progressed over the past year. The patient reports difficulty driving at night and reading small print. The clinician obtains a focused history including onset, refractive change, and prior corrective lens prescriptions. Visual acuity is measured with and without current spectacles. A refraction is performed using objective techniques (autorefractor, retinoscopy) followed by subjective refinement to determine best-corrected visual acuity and the exact spherical and cylindrical power required for corrective lenses or contact lenses.

    The clinical workflow includes: pretest visual acuity and ocular history by a technician; preliminary autorefraction; clinician-performed manifest refraction and subjective testing; binocular balancing and near vision assessment when indicated; documentation of final spectacle or contact lens prescription; counseling on lens options and follow-up. Typical settings are optometry offices, ophthalmology outpatient clinics, or optical dispensaries co-located with eye care practices.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    92004Comprehensive eye exam, new patientPerformed when a new patient requires a full medical and ocular evaluation in addition to refraction; refraction may be billed separately when appropriate.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    152W00000X
    207W00000X
    152WC0802X
    261QM3000X
    364SP0200X
    364SH1100X
    133VN1006X
    2472B0301X

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mappingpremerabluecrossofwashington2027-02-05
    Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mappingpremerabluecrossofwashington2027-02-05
    Navigated Transcranial Magnetic Stimulation for Preoperative Brain Mappingpremerabluecrossofwashington2027-02-05
    Calcitonin Gene-Related Peptide (CGRP) Inhibitors: Vyepti (eptinezumab-jjmr)Mass General Brigham Health Plan2027-01-04
    Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)Kaiser Permanente2027-01-01
    Open Neuroplasty Lumbar PlexusCigna2026-12-15
    Laser Interstitial Thermal TherapyCigna2026-11-15
    Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)bcbsvermont2026-11-01
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Microdiscectomyuniverahealthcare2026-10-15

    Related Codes

    CPT-92018-EYE-EXAM-UNDER-GENERAL-ANESTHESIA

    CPT 92018: Eye Examination Under General Anesthesia

    CPT-92019-LIMITED-EYE-EXAM-UNDER-GENERAL-ANESTHESIA

    CPT 92019: Limited Eye Examination Under General Anesthesia

    CPT-92020-GONIOSCOPY-ANTERIOR-CHAMBER-ANGLE-EXAMINATION

    CPT 92020: Goniometry of Anterior Chamber Angle

    CPT-92025-CORNEAL-KERATOMETRY-INTERPRETATION-REPORT

    CPT 92025: Keratometry (Corneal Curvature Measurement)

    CPT-92060-COMPREHENSIVE-OCULAR-MOTILITY-AND-BINOCULAR-FUNCTION-EXAM

    CPT 92060: Comprehensive Eye Sensorimotor and Deviation Measurement

    CPT-92065-VISION-THERAPY-PATIENT-TRAINING

    CPT 92065: Vision Therapy Patient Exercise Training

    CPT-92066-VISION-THERAPY-PATIENT-TRAINING

    CPT 92066: Training Patient in Vision Therapy Exercises

    CPT-92071-THERAPEUTIC-SOFT-CONTACT-LENS-APPLICATION-OCULAR-SURFACE-DISEASE

    CPT 92071: Soft Contact Lens Application for Ocular Surface Disease

    CPT-92072-SOFT-CONTACT-LENS-FITTING-KERATOCONUS

    CPT 92072: Initial Soft Contact Lens Fitting for Keratoconus

    CPT-92081-LIMITED-VISUAL-FIELD-EXAMINATION-INTERPRETATION

    CPT 92081: Limited Visual Field Examination

    Showing 1–10 of 19

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    92014
    Comprehensive eye exam, established patient
    Performed for established patients needing a comprehensive medical eye evaluation; refraction is often an add-on service to document refractive correction.
    92002Intermediate eye exam, new patientUsed for new patients needing problem-focused follow-up or intermediate-level exam; refraction may be performed during the visit if indicated.
    92012Intermediate eye exam, established patientUsed for established patients with limited ocular complaints where refraction is performed as part of the visit.