Ophthalmology Billing That Pays What You Earn
Ophthalmology billing operates at the intersection of medical and surgical coding — with eye exam E&M codes, ophthalmic-specific codes, surgical procedure codes, and optical dispensing all within one practice. Medicare Advantage plans increasingly require prior auth for retinal injections, cataract surgery, and laser procedures. 360Solutions provides ophthalmology billing specialists who manage the unique eye code system, intravitreal injection billing, and surgical global period tracking with specialty-specific expertise.
Where Ophthalmology Practices Lose Revenue
These are the coding and billing pitfalls that cost ophthalmology practices the most — and where our specialised billers add the most value.
Eye Exam Code vs. E&M Selection
Ophthalmology has its own exam codes (92002–92014) that are alternatives to standard E&M codes. Choosing between the eye code system and E&M depends on medical complexity and payer rules. Wrong selection results in underpayment or payer rejection.
Intravitreal Injection Billing
Anti-VEGF injections (Lucentis, Eylea, Avastin, Vabysmo) require J-code drug billing, procedure coding (67028), and prior auth management. Drug units must match the dose documented, and payer drug policies vary widely.
Cataract Surgery Global Period
Cataract surgery (66982/66984) carries a 90-day global period. Post-op refraction, spectacle prescription, and IOL power calculations are typically bundled. We track global periods and ensure only separately billable services are billed outside the package.
Laser Procedure Prior Auth
LASIK, PRK, and other refractive procedures are typically non-covered cosmetic services, but laser for glaucoma (SLT), retinal tears, and diabetic macular edema are covered. We apply correct medical necessity diagnoses and manage auth for covered laser procedures.
High-Risk CPT Groups
Code ranges payers audit most aggressively in Ophthalmology.
Common Denial Patterns
Knowing these before submission is the difference between a 60% and a 96% first-pass rate.
Eye exam code billed with payer that requires standard E&M codes (or vice versa)
Anti-VEGF drug J-code units do not match documented dose in injection record
Post-op visit billed within 90-day global without documented new problem
Cataract surgery prior auth obtained under wrong lens complexity code
Refraction billed to Medicare (non-covered service — patient must pay directly)
Send us your last 90 days of remittance data — we'll identify your top 3 fixable denial sources at no cost.
Request Free Audit →How 360Solutions Works for Ophthalmology Practices
Free 2-Week Billing Audit
We review your last 90 days: denial breakdown by category, AR aging by payer, charge lag, collection rate, and any recurring coding issues specific to your specialty. No commitment required.
Specialty Coder Assignment
You are paired with a coder trained specifically in ophthalmology coding. They learn your providers, your documentation patterns, and your payer mix before touching a claim.
Parallel Billing Transition
We run alongside your current billing for 10–14 days with zero cash flow disruption. Claims keep moving during the transition. Your account manager provides daily status updates.
Live KPI Dashboard
Real-time visibility into billed, paid, denied, AR aging, and collection rate — segmented by provider and payer. No black box, no month-end surprises.
Weekly Account Manager Call
Every week your dedicated account manager walks through last week's KPIs, denial trends, and any action items. Critical issues are escalated the same day — not at the next scheduled call.
Questions From Ophthalmology Practices
Start With a Free,
No-Obligation Audit
Two weeks, no contract. A certified ophthalmology billing specialist reviews your claims, denial patterns, and AR — and shows you exactly what is recoverable.