WHAT IS A REFRACTION? WILL MY INSURANCE COMPANY PAY FOR THIS?
 
 

A refraction is the determination whether your child needs glasses.  An auto-refraction may also be done. Auto-refraction is a special instrument reading which can estimate the degree of near-sightedness, far-sightedness or astigmatism that is present in each eye. 

Older children and adults can be further assessed by placing them behind a special instrument called a phoropter.  They are then asked to compare different lenses to see which lens allows them to see their best ("better 1 or better 2").  This is called a "manifest refraction".

Younger children who are not yet old enough to undergo a manifest refraction are best assessed for glasses by undergoing dilation of their eyes.  The doctor can then determine the need for glasses by using an instrument called a retinoscope in conjunction with a series of hand held lenses to assess certain light reflections from each eye.  This is called a "cycloplegic refraction" and is the basis for prescribing glasses in young children.

Billing for eye examinations is done using standardized coding (CPT coding).  The refraction is not considered as part of the general eye examination codes or the general medical codes.  The refraction therefore is coded separately to the examination code when a refraction is performed.  Sometimes a refraction may not be indicated (for examaple a child being evaluted for an eye injury) and just an eye examination or medical examination code will be billed. 

A refraction is typically performed once per year in children who wear glasses.  Children with strabismus (lazy eye) and/or amblyopia (lazy vision) also require periodic refractions to determine if glasses are needed as part of their treatment regimen.  A refraction may need to be done in some children more than once a year if the glasses prescription is changing more rapidly than usual or if an eye misalignment worsens as this may also indicate a need to change the glasses.

The refraction fee is usually considered a "non-covered" service by medical insurance companies.  If this is the case, the parent will be responsible for payment of the refraction fee in addition to any co-payments due for the medical portion of the examination.