Your Questions Answered: Routine vs Medical Eye Exams

Thursday, January 23, 2020

Here at Thomas Eye Group, we want to be able to answer all your questions so you can be both comfortable and healthy. Below we have answered a list of the most commonly asked questions we get from patients in hopes that it will answer the question you clicked on this blog for! If you don’t find your question here, feel free to call and ask at 678-892-2020.

What is a Routine Vision Exam?

A routine vision exam is performed for a patient who has no specific illness, symptoms, complaints, or injury that needs to be treated or diagnosed. The visit will be a comprehensive exam checking the overall health of the eye, screening for potential indicators of eye disease and if applicable, supply glasses or contact lens prescription. If your doctor finds anything abnormal during your routine eye exam, further testing of a medical nature may be needed.

In this case, your initial visit will be billed as a routine eye exam, and any subsequent visits will be billed as a medical visit. Routine eye exams do not qualify for prescribing medications. Your symptoms and eye examination will determine how your visit is coded and billed to your insurance.

What is a Medical Eye Exam?

A medical eye exam is performed for a patient who is being evaluated or treated for a medical condition, symptom, complaint or injury. The visit will be a comprehensive examination for the diagnosis and treatment of disease or condition of the eye. It will evaluate the reasons for the symptoms or complaints and assess any treatment needed. Some examples of diseases or conditions evaluated in a medical exam include but are not limited to: cataracts, glaucoma, diabetic retinopathy, macular degeneration, dry eye, conjunctivitis, allergies, and eye muscle imbalance, headaches. 

Your symptoms and eye examination will determine how your visit is coded and billed to your insurances. We hope this information will help you to understand how your visit is submitted to your insurance for today’s visit and future visits with Thomas Eye Group. If you have any further questions please see a representative upon your arrival at your appointment.


Thomas Eye Group participates in the Medicare program. We accept assignments of benefits on behalf of each eligible patient. The medical examination is covered at 80% of their approved services after the deductible has been met. However, as mandated by Federal law, the refraction (calculation of your glasses prescription) is a non-covered service.

Each Medicare patient will be charged a separate fee for the refraction. This charge must be paid for at the time of service during your visit.

Routine Eye Exam vs. Medical Eye Coverage

Regular eye examinations are important to your overall eye health and vital in maintaining vision for your lifetime. In order to understand how the billing of your visit will be handled, it’s important that you be aware of your insurance benefits and how they apply to your appointment.

Ultimately, it is your responsibility to know what your insurance policy will or will not cover. Be sure of your policy to determine benefit coverage prior to your visit. 

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