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Billing code

E423A — Manual cycloplegic refraction premium

Child cycloplegic refraction add-on

Add to A233 or A234 when an ophthalmologist personally does a manual cycloplegic refraction for strabismus or amblyopia in a child 15 or younger.

Watch for: Must be billed with A233 or A234; limit 2 per patient per physician per 12 months.

Code

E423A

Description

Manual cycloplegic refraction premium

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2025

Termination date

No end date

Explanation

Updated October 26, 2026

Add-on to an ophthalmology specific or partial assessment (A233/A234) for a manual cycloplegic refraction in a child 15 or younger.

What it covers

Manual cycloplegic refraction is a service rendered personally by an ophthalmologist to evaluate patients up to and including 15 years of age for strabismus and/or amblyopia that requires glasses or contact lenses (A155).

It is billed as an add-on to an ophthalmology specific assessment (A233) or partial assessment (A234) (A155).

Billing rules

• Add-on only: bill with A233 or A234 (A155).
• Must be rendered personally by the ophthalmologist (A155).
• Patients up to and including 15 years of age, for strabismus and/or amblyopia needing glasses or contact lenses (A155).
• Maximum of 2 per patient per physician per 12 months (A155).
• Not listed in Appendix J, so it is not payable as a virtual service (AJ1–AJ2).

Often billed with

• A233 specific assessment or A234 partial assessment (A155).
• E424 when the child is under active amblyopia treatment (A155).

Common rejections

• AD9: Premium not allowed alone: E423 must be billed with A233 or A234 on the same claim (A155).
• AM1: Service limit exceeded: E423 is limited to 2 per patient per physician per 12 months (A155).

Related codes: A233, A234, E424, A230, A237

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Ophthalmology (23), page A155.

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