Medicare does not cover refraction exams, even after cataract surgery. The exclusion is broad and explicit: the Medicare Benefit Policy Manual states that “eye refractions by whatever practitioner and for whatever purpose performed” are not covered. This surprises many people because Medicare does cover cataract surgery itself and even a pair of glasses afterward, but the refraction needed to write that glasses prescription falls into a coverage gap.
Why Refraction Is Excluded
Refraction is the part of an eye exam where your doctor determines your exact lens prescription, typically by having you look through a series of lenses and say which is clearer. Medicare classifies this as a “routine” service and groups it alongside routine physicals, hearing aid exams, and eyeglass fittings as specifically excluded benefits under the Social Security Act. This exclusion applies regardless of the reason for the refraction or who performs it.
This means that even when refraction is medically necessary to complete your post-surgical care, Medicare treats it the same as a routine eye check. Your surgeon still needs to do a refraction to prescribe your new glasses after cataract surgery, but Medicare considers the refraction itself your financial responsibility.
What Medicare Does Cover After Cataract Surgery
Medicare Part B covers cataract surgery that implants an intraocular lens. It also covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery. That post-surgical eyewear benefit is unusual for Medicare, which normally doesn’t cover glasses or contacts at all.
The catch is obvious: you need a refraction to get an accurate glasses prescription, but Medicare won’t pay for the refraction that makes those covered glasses possible. So you’ll likely pay for the refraction out of pocket, then use your Medicare eyewear benefit for the glasses themselves. The surgery, the follow-up visits during the 90-day recovery window, and the glasses are covered. The refraction is not.
What You’ll Pay for the Refraction
The good news is that refraction is one of the least expensive parts of eye care. Out-of-pocket costs typically range from about $25 to $75 at most practices, though prices vary by location and provider. Some offices charge even less. If you have a Medicare Supplement (Medigap) plan or a Medicare Advantage plan with vision benefits, check whether those cover refraction, as some do.
Before performing the refraction, your provider’s office should give you a form called an Advance Beneficiary Notice of Noncoverage (ABN). This is a standard CMS form that tells you Medicare won’t pay for a specific service and asks you to acknowledge that you’ll be responsible for the charge. If your office doesn’t mention it, ask about the cost upfront so there are no surprises on your bill.
Timing: Refraction During the Post-Op Period
Cataract surgery comes with a 90-day “global period,” meaning your follow-up visits during that window are bundled into the cost of the surgery. Refraction, however, is not bundled into this global surgical package. Your doctor can bill for it separately at any point during those 90 days. In practice, most surgeons wait about four to six weeks after surgery before doing a final refraction, since your vision continues to stabilize during that time. Getting your prescription too early can result in glasses that don’t work well once your eye fully heals.
Because the refraction is billed separately from the surgery’s global package, you’ll see it as a distinct charge. It will be billed under CPT code 92015, and since Medicare denies this code, the full amount comes to you. Again, this is typically a modest charge compared to the surgery and eyewear costs.
How to Make the Most of Your Eyewear Benefit
Once your refraction is done and your new prescription is stable, you can use your Medicare Part B benefit for one pair of glasses with standard frames or one set of contacts. A few practical points to keep in mind:
- One pair per surgery: If you have cataract surgery on both eyes at different times, you’re entitled to a pair of glasses after each procedure. Many people wait until both eyes are done before filling a prescription.
- Standard frames only: Medicare covers basic frames. If you choose upgraded or designer frames, you pay the difference.
- Part B cost-sharing applies: You’ll still owe the Part B deductible (if you haven’t met it) and the standard 20% coinsurance on the glasses.
- Use a Medicare-participating provider: Your eyewear supplier needs to accept Medicare assignment for the benefit to apply.
Planning the timing of your refraction and glasses order around both eyes’ surgeries can save you money and ensure you end up with the most accurate prescription possible.