Home | Vision & Ophthalmology Medical Billing
Vision & Ophthalmology Medical Billing: Clean Claims for Eye Care Practices
Billing for Ophthalmology and Optometry Practices
Billing Benefit handles medical billing for ophthalmologists, optometrists and multi-provider eye care groups. We code exams, diagnostic testing and surgery correctly, bill medical insurance and vision plans the right way, and follow up on every claim until it is paid, so your team can focus on patients. Not sure where your revenue is slipping? Start with a free medical billing audit.
Ophthalmology Billing
Exams, diagnostic testing and surgery
Ophthalmology claims depend on choosing the right code family and documenting medical necessity. We bill eye exam codes (92002, 92004, 92012, 92014) or E/M visits, whichever fits the visit, plus diagnostic tests such as OCT (92133, 92134), visual fields (92083) and fundus photography (92250).
For surgery we handle cataract procedures (66984, 66982) with their global periods and modifiers (RT, LT, 24, 25, 57, 79), and intravitreal injections (67028) with the drug billed by its J-code and units, with prior authorization checked first. Clean coding at this level is what keeps denials low.
Optometry and Routine Vision Billing
Medical insurance or vision plan?
A routine eye exam goes to the patient's vision plan; a medical eye problem goes to their medical insurance. We sort each visit the right way, bill vision plans such as VSP, EyeMed and Davis Vision, and handle refraction (92015), which Medicare does not cover, so it is collected from the patient up front instead of written off.
We also bill contact lens fittings and materials such as frames and lenses with the correct supply codes.
Looking for vision billing software? We are a billing service, not a software vendor: you keep the practice management system you already use, and our team works the claims for you.
Full Revenue Cycle Management
From eligibility to payment
We handle the whole cycle for eye care practices: eligibility checks for both medical and vision coverage, prior authorization for injections and surgery, charge entry and coding, clean claim submission, payment posting, denial management and A/R follow-up. Denied claims are corrected or appealed with the exam notes and test results, and every month you get a clear report on collections, denials and what is still open.
Dedicated Support for Your Practice
One team that knows eye care
You get one point of contact and billers who know ophthalmology and optometry. We keep your providers' credentialing current with Medicare, Medicaid, commercial plans and vision plans, and we answer your staff's billing questions quickly. We work with practices across Texas from our Sugar Land office and support eye care practices nationwide. Book a free consultation to see what we would change in your billing.
Common Eye Care Billing Problems We Fix
| Billing problem | Why it costs you | How we fix it |
|---|---|---|
| Medical versus routine vision | The same exam can go to a vision plan or to medical insurance depending on the reason for the visit | We pick the right payer from the chief complaint and diagnosis |
| Refraction not collected | Medicare and many medical plans do not cover refraction (92015) | We make sure refraction is collected from the patient or billed to the vision plan |
| Diagnostic testing limits | OCT, visual fields and photos have frequency limits and need a supporting diagnosis | We check limits and diagnosis codes before billing |
| Cataract surgery co-management | Post-op care is included for 90 days and may be shared with an optometrist | We bill co-management with modifiers 54 and 55 |
| Injectable drugs | Anti-VEGF injections need the right drug code, units and eye modifier | We bill 67028 with the drug, units and RT or LT |
Vision and Ophthalmology Billing FAQs
When should an eye exam be billed to medical insurance instead of a vision plan?
When the visit is for a medical problem, such as an eye disease, injury or symptom, it is billed to medical insurance. Routine exams for glasses or contacts go to the vision plan.
Does Medicare pay for refraction?
No. Refraction (92015) is not covered by Medicare, so it is usually collected from the patient.
How is cataract surgery co-management billed?
The surgeon bills the surgery with modifier 54 and the doctor providing post-op care bills the same code with modifier 55, and both show the date care was transferred.
Do you bill both ophthalmology and optometry practices?
Yes. We bill medical eye care, surgery and routine vision services, and work with both medical insurers and vision plans. See all the specialties we bill for.
Not Sure Where Your Revenue Is Leaking?
Get a free, no-obligation medical billing audit. We review your claims, denials and A/R, then show you what to fix first.
