By law, Medicare does not pay for routine vision exams “…for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses for refractive errors.”  Medicare beneficiaries may choose to have routine or annual eye exams, however, the beneficiary would be responsible for payment. Some beneficiaries have vision insurance that may cover the exam.

This FAQ addresses the following:

1. Does Medicare cover “routine” or “annual” exams?
2. Is an ABN required for a routine exam on a Medicare patient?
3. Do major medical plans cover routine eye exams?
4. If a patient has both medical and vision insurance, which is primary?
5. When a patient comes for a routine vision exam and pathology is found, may we bill the medical plan?
6. Which plan is responsible if a patient needs urgent, same day medical and/or surgical care?
7. Is it ever possible to bill both medical and vision insurance?
8. What if a patient asks our staff to modify a claim to avoid personal responsibility?
9. How do we reduce confusion with patients on this subject?
10. What happened to the local codes that used to describe a routine eye exam?