Wrong plan billed
Medical visits sent to vision plans or the reverse. Chief complaint reviewed before billing.
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Optometry medical billing services
Optometry bills medical eye care under insurance and routine vision under vision plans, and knowing which is which for each visit determines payment. Medical visits, testing and co-management of surgical patients follow the ophthalmology rules; routine exams and materials follow vision plan rules.
What makes optometry billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether optometry claims pay the first time.
- Medical eye visits (eye codes or E/M) are billed to medical insurance when the chief complaint is medical; routine exams go to vision plans.
- Diagnostic testing — OCT, fields, photography — follows medical-necessity and frequency policies.
- Co-management of cataract and other surgeries uses modifier 55 for the post-operative portion.
- Contact lens fitting (92310–92317) and materials have vision-plan-specific coding and limits.
Denials we see most in optometry
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Testing frequency
Tests denied as too frequent. Tracked per payer.
Co-management splits
Post-op care denied for incorrect modifier. Coordinated with the surgeon.
How Core MB bills for optometry
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new optometry providers runs in the same system, tracked live in your client portal.
- Medical versus vision determination per visit.
- Testing frequency and necessity tracking.
- Surgical co-management billing.
Everything in the service
The full revenue cycle as standard for optometry 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
Optometry billing questions
How do we decide medical versus vision billing?
By the chief complaint and the reason for the visit. A medical problem goes to medical insurance even if a refraction is also done; a routine exam goes to the vision plan.
Can optometrists bill medical insurance?
Yes, for medical eye care, with the same codes and rules ophthalmologists use, subject to state scope and payer enrollment.
Do you bill the post-op portion of cataract co-management?
Yes, with modifier 55 and coordination with the surgeon's billing.
How do we get started with Core MB for optometry 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 optometry providers can start at the same time.
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Find out what your optometry 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.