Ophthalmologist examining patient

Ophthalmology Billing That Sees the Big Picture

Between complex surgical bundling rules, vision plan limitations, and ever-changing Medicare policies for eye care, ophthalmology billing requires 20/20 precision. We help practices navigate these challenges—so you can focus on patient vision rather than claim denials.

Last quarter alone, we recovered $214,000 in previously denied claims for a 9-provider ophthalmology group by correcting modifier usage and surgical documentation. But beyond the numbers, we give you back the time and confidence to concentrate on patient care.

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Comprehensive Eye Exam Coding

We ensure accurate coding for all vision services while navigating these key distinctions:

Routine vs Medical

  • 92004 vs 99204 documentation
  • Vision plan vs medical billing

Specialty Exams

  • Glaucoma workups (92133-92134)
  • Diabetic eye exams (92250)

Documentation Tip: For comprehensive eye exams, we ensure your notes include:

✓ Chief complaint ✓ External/internal exam findings ✓ Diagnosis/assessment ✓ Treatment plan

Diagnostic Testing & Modifier Precision

We navigate the complexities of ophthalmic diagnostics:

Imaging Tests

  • OCT (92134)
  • Fundus photos (92250)

Visual Fields

  • 92081-92083 coding
  • Frequency limitations

Modifiers

  • RT/LT for laterality
  • TC/26 for technical vs professional

Pro Tip: We maintain a database of payer-specific policies for ophthalmic diagnostics, updated quarterly.

Surgical Billing Expertise

We handle the nuances of ophthalmic surgical billing:

Cataract

66984, 66982 with IOL

Retina

67028, 67036 injections

Glaucoma

65855, 66174 procedures

Our Surgical Billing Process:

  1. Verify global period requirements
  2. Apply correct surgical modifiers
  3. Document medical necessity
  4. Track post-op visits

Vision Plan & Payer Credentialing

We streamline enrollment with all major vision and medical plans:

Vision Plans

  • VSP enrollment
  • EyeMed credentialing

Medical Plans

  • Medicare enrollment
  • Commercial payer contracts

Our Credentialing Advantage:

✓ Average 45-day turnaround ✓ 100% CAQH compliance ✓ Vision plan fee schedule analysis

"Their team increased our collections for cataract surgeries by 38% by properly applying global period modifiers and documenting complex cases. They also handle all our VSP and EyeMed billing—we no longer have to worry about vision plan claim rejections."

Dr. Sarah Chen

ClearVision Ophthalmology

Ready to Sharpen Your Revenue Focus?

Get a free analysis of your last 90 days of claims. We'll identify your top opportunities to:

  • Reduce surgical denials
  • Optimize diagnostic testing
  • Maximize vision plan revenue
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