Testing frequency denials
OCT or fields denied as too frequent. We track frequency per payer and code necessity precisely.
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Ophthalmology medical billing services
Ophthalmology bills under two E/M systems — standard codes and eye codes (92002–92014) — plus testing, injections and surgery with global periods. Choosing the right visit code family, billing testing correctly and managing intravitreal injection drugs are where revenue is won or lost.
What makes ophthalmology billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether ophthalmology claims pay the first time.
- Eye codes and standard E/M codes have different documentation requirements and payer preferences; the better-paying, defensible choice varies by visit and payer.
- Diagnostic tests — OCT (92134), visual fields (92083), fundus photography (92250) — have frequency limits and medical-necessity policies.
- Intravitreal injections (67028) and the drug (aflibercept, ranibizumab, bevacizumab) need authorization, correct J-codes, units and wastage billing.
- Cataract and other surgeries have 90-day global periods; co-management with optometry uses modifiers 54 and 55.
Denials we see most in ophthalmology
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Injection drug errors
Drug lines denied for units or authorization. Managed per injection.
Co-management modifier errors
Surgical claims denied for incorrect 54/55 split. We coordinate with the co-managing optometrist.
How Core MB bills for ophthalmology
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new ophthalmology providers runs in the same system, tracked live in your client portal.
- Visit code selection (eye codes versus E/M) by documentation and payer.
- Testing frequency tracking and medical-necessity coding.
- Injection drug billing with authorization, units and wastage, and surgical co-management splits.
Everything in the service
The full revenue cycle as standard for ophthalmology practices, priced on what we collect for you. Take all of it, or start with one piece such as AR recovery or credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Ophthalmology billing questions
Should we use eye codes or regular E/M codes?
It depends on the documentation and the payer. We select per visit based on what is documented and what each payer pays, within the rules.
How do you handle intravitreal injection billing?
With authorization management, the right J-code and units for each drug, and wastage reporting, plus the injection procedure code.
Do you support surgical co-management?
Yes. We apply modifiers 54 and 55 correctly between the surgeon and the co-managing provider.
How do we get started with Core MB for ophthalmology billing?
Send us your specialty, provider count and monthly claim volume through the quote form and we will come back with a written proposal. Transitions run alongside your current billing so nothing is dropped, and credentialing for new ophthalmology providers can start at the same time.
Find out what your ophthalmology billing is leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.