FC Billing provides Optometry billing and coding services in all states in USA. Correct Optometry billing and coding is an essential part of a successful eye care practice. Optometry has an unique set of office visit codes which are not used by any other specialty. These codes are referred to as Eye Codes.

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Having a thorough understanding of when to bill with Eye Codes and when to avoid them is crucial to Optometry billing success. Evaluation and Management (E&M) codes have new criteria since January 1, 2021.

E&M codes are now chosen based on medical decision making and time. Because of the new standard, Optometrists are able to easily use E&M codes to increase reimbursement. Knowing the reimbursement rate is very important in choosing codes for billing. Insurance contracts need to be current and fee schedules need to be reviewed each year. Optometry coding will also depend on the nature of the visit. All practice staff have to have a good understanding of requirements for Optometry billing for both vision and medical visits.

Optometry Billing Services

We work with Optometrists in many different regions of USA.

  • Vision claim billing
  • Medical claim billing
  • Workman compensation billing
  • Co-Management claim billing
  • Verification and prior Authorization
  • Credentialing
  • Documentation audit
  • Revenue assessment
Optometry billing Services

Covered Services for Optometry

Optometry billing Vision Coverage

1. Vision Coverage

Vision insurance plans cover annual eye exams, which includes prescription check for eyeglasses and/or contact lenses, and supplies. To avoid any surprise billing, the office needs to verify coverage before appointing patient. Vision plans, such as Blue View Vision, Davis Vision, EyeMed, March Vision, Spectra, VSP etc., have different plan benefit for patients to choose from; therefore, it is important not to assume type of coverage. Many Medicare advantage plans now have vision coverage as well. Tricare and Medicaid plans might also have vision coverage for members. Best practice is always to verify coverage before patient’s visit. Some vision insurances, such as VSP, might also offer limited medical coverage for patients with certain medical conditions, such as Diabetes.

2. Medical Coverage

Medical plans mostly cover medical diagnosis and treatment. Patients coming to an eye doctor might automatically assume that visit will be billed to vision insurance, especially if patient will be seeing an Optometrist. Vision insurances have little to no co-pays. They also might not have any co-insurance or deductible. Medical insurance might have higher co-pays, co-insurance, and deductible. If the patient is making an appointment for a medical issue, the provider’s office needs to clearly explain to the patient which insurance will be billed and why. When possible, it is always a good idea to collect any due amount on the day of the visit with a clear explanation to the patient for the reason for charges.

Optometry billing-Medical Coverage
Optometry billing-Co Management Billing

3. Co-Management Billing

Many Optometrists choose to co-manage cataract patients with Ophthalmologists. Successful co-management requires good communication between the two practices. Optometry biller has to have certain information from the surgeon’s biller in order to bill for co-management services. Optometrist should also receive the operative note to keep in patient’s file. When co-management is done correctly, excellent care can be provided to patients. We are able to process co-management claims for quick reimbursement. Call us for details.

Optometry billing and Coding Challenges

  • Generating patient estimation for covered services
  • Identifying benefits and responsibility for vision plans
  • Maintaining proper documentation and authorization for services
  • Billing and coding knowledge
  • E&M coding criteria
  • Knowledge of bundled codes
  • Usual and customary fees for services
  • Claim rejections and denials
  • Unpaid claims
  • Account receivable
  • Insurance credentialing
Optometry billing and Coding Challenges

Optometry Billing Pearls

  • Verify patients’ benefits for both vision and medical plans. This way the practice, provider, and patient can make informed decision.
  • Vision claims should be billed with eye codes, 92002 or 92004, and 92012 or 92014.
  • Vision insurance covers limited services. Routine vision care is allowed once per year or every 24 months, depending on the plan.
  • Providers should not bill office visit to medical and vision insurances on the same day.
  • Know when to bill 92250 (Fundus photos), 92083 (Visual Fields), and 92133/92144 (OCT).
  • Co-management claims require a specific set of information on the claim about the surgery.

What Makes Us Different?

  • We use proven successful billing strategies
  • We verify prior authorization requirements
  • We have expert knowledge of Ophthalmology and Optometry Billing
  • Member of AAO (American Academy of Ophthalmology)
  • We understand local payers
  • We are result driven
  • Our communication is HIPAA compliant
  • We are expert in credentialing management
  • We follow up on all unpaid claims for reimbursement
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Refraction is a separate billable service. Only few insurances bundle refraction with office visit for annual vision exams.

Traditional Medicare does not cover refraction, but Medicare Advantage plans might, so it is very important to verify coverage before performing refraction.

Every plan, except traditional Medicare, has the possibility of routine exam coverage. This can be verified through the billing software, clearing house, insurance portal, or by directly contacting insurance.

Some vision insurances cover limited medical tests for certain diagnoses. Coverage needs to be verified with insurance.

E modifiers are used on Medicare claims and any insurance which follows Medicare rules. LT and RT modifiers are used for billing commercial insurances.

If the patient is new to the practice, you can bill office visit with procedure using the same diagnosis code; remember to add proper modifiers. However, for established patient, you need to have a significant and separate diagnosis to bill office visit.

If you are covering for the provider, you can bill services that the primary provider is able to bill. If a patient has reached frequency limit for any test or procedure with any other doctor, insurance will not pay for any additional performance of the same test or procedure.

Both co-management doctors have to put proper modifiers and transfer of care information on claims.

Yes, 99050, however most insurances consider it a bundled service.