Ophthalmology Billing Services
Ophthalmology billing requires navigating the line between medical and vision coverage for every single patient encounter. A comprehensive eye exam billed to medical insurance uses different codes than a routine vision exam billed to a vision plan. Many patients have both medical and vision coverage, and the diagnosis determines which payer is primary. Routing the claim to the wrong payer means a denial and a rebill that delays payment by weeks.
We bill for ophthalmology practices performing everything from routine eye exams to retinal surgeries and cataract procedures. We understand the distinction between 920xx eye codes and 992xx E&M codes, when to use medical vs. vision plan routing, and how to capture all separately billable diagnostic tests during a single encounter.
Ophthalmology billing at a glance
Common ophthalmology procedures we bill daily.
Surgical Procedures
Diagnostic Testing
Office Procedures
Ophthalmology billing challenges we solve every day.
Ophthalmology is one of the most complex specialties to bill. High-value procedures, strict documentation requirements, and frequent payer policy changes mean even experienced in-house billers miss revenue. For coding standards, see the American Academy of Ophthalmology.
Medical vs. vision plan routing
The primary diagnosis determines whether the claim goes to medical insurance or a vision plan. Diabetic retinopathy goes to medical. Myopia goes to vision. A patient presenting with both requires two separate claims to two different payers for the same encounter. We route every claim to the correct payer based on the documented diagnoses.
Refraction bundling
Refraction (92015) is not covered by Medicare but is covered by many commercial plans. When performed during the same visit as a comprehensive eye exam, some payers bundle it while others pay separately. We append the correct modifier and bill refraction to the appropriate payer when coverage exists.
Cataract surgery coding complexity
Cataract surgery (66984) has specific rules for premium IOL billing. The surgical code covers the basic monofocal lens. Toric, multifocal, and extended depth-of-focus lenses require additional patient out-of-pocket charges and specific billing procedures outside the insurance claim. We coordinate the insurance billing and patient billing components to capture full revenue.
Intravitreal injection frequency
Anti-VEGF injections for macular degeneration and diabetic eye disease are high-cost, high-frequency procedures. Each injection uses expensive drugs (Eylea, Lucentis, Avastin) that may be billed as buy-and-bill or through a specialty pharmacy. Drug wastage modifiers (JW) affect reimbursement. We track injection schedules, drug inventory, and payer-specific drug billing requirements.
Full-service ophthalmology billing across your revenue cycle.
Simple, transparent ophthalmology billing pricing.
We also bill for these specialties.
Ready to fix your ophthalmology billing?
Schedule a free consultation. We’ll review your current billing performance, identify where you’re losing revenue, and build a plan to get your ophthalmology practice paid faster.
