We conduct 2 types of Vision Exam at Maricopa Eye Care:

• Routine Vision Exam
• Medical Vision Exam

Whether your Vision Exam is classified as ‘Routine’ or as ‘Medical’ depends on your medical history and on the doctor’s exam findings.  This classification impacts costs, as well as what type of insurance will be billed for your exam.

Routine Vision Exam:   A Routine Vision Exam is conducted when you have completely healthy eyes and no systemic illnesses or medications that can impact the eyes.  In a Routine vision exam, your vision corrects to 20/20 with the right lenses, the test data is uncomplicated, and the coding and documentation requirements are fairly simple.  These exams take less time and are less expensive than medical vision exams.  Routine eye exams can be billed to routine vision insurance, with the exception of retinal screening photos, which are an out of pocket charge, which is discounted to $39.

Medical Vision Exam:  Your exam will be classified as a Medical Vision Exam if you have medical issues with your eyes or if you take medications or have systemic illness that can impact the eyes.  These exams require more complex analysis and a higher level of documentation than exams on people who only have glasses-related issues.  Eye exams for patients with medical issues must be coded and documented a bit differently than routine eye exams; they take more time and are more expensive.   These exams are NOT billable under routine vision insurance, but they ARE billable under major medical plans, with the exception of the refraction ($30-45) and retinal screening photos (discounted to $39).  In some cases, retinal photos may be billed to medical insurance.  If we find this to be the case, the $39 paid will be refunded. Your medical insurance’s regular deductibles, copays and coinsurance still apply.

Here are some of the reasons your vision exam would be classified as Medical, not Routine:

• Diabetes or Prediabetes
• Emerging cataracts, even if they are not yet at a surgical state
• History of cataract surgery or any other eye surgery
• High eye pressure or being classified as a Glaucoma suspect
• History of Glaucoma or Macular Degeneration
• Flashes of light or floaters in your vision
• Double vision
• Vision that does not correct to 20/20, even with the best test-lenses possible
• History of a lazy eye

Please be prepared for the possibility that your exam could be classified as Medical, even if it has been classified as Routine in the past.  Peoples’ eyes change over time and our billing policies have evolved as well, to better align with the updated rules of the insurance carriers with whom we are contracted.  We’ll do our best to predict which way your exam will be classified, but it will ultimately be determined by the doctor’s exam findings.  If you have medical findings, your exam WILL be classified, coded and billed as medical.