CPT 92015, in plain terms, covers Refraction determination measuring how the eye focuses light to assess refractive error and need for optical correction. CPT 92015 is referenced in 3 tracked payer policy changes from Connecticut Medicaid (HUSKY Health), Aetna Better Health of Virginia, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92015 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 92015 on AAPC
Connecticut Medical Assistance Program (CMAP) is increasing reimbursement rates for eight optometry procedure codes effective July 1, 2026. The rates for these codes will now match physician reimbursement rates under CMAP. Billing teams must update fee schedules in their billing systems to reflect the new rates for CPT codes 92004, 92014, 92015, and 92250 with applicable modifiers.
Aetna Better Health of Virginia is correcting an error that caused claims to be wrongly denied when E&M services were billed together with specific ophthalmological procedure codes. The payer has removed these codes from the denial trigger list retroactively to July 1, 2025, and will automatically reprocess all affected claims after system updates are complete by February 1, 2026.
Alaska Medicaid clarifies that vision exams are limited to one per calendar year, with additional exams for children requiring medical justification and adults requiring prior authorization. The policy specifies which CPT codes are subject to this limit and outlines required components for covered vision exams.
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