Eye exam
92002–92014 or E/M
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Ophthalmology Billing Services
Ophthalmology billing keeps the eye exam and the surgical claim on different codes — then medical vs vision routing, OCT medical necessity, anti-VEGF drug units, and cataract globals. Vector Medical Billing, in Jamaica, New York, tracks each eye’s global clock inside the EHR you already use.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly fee
What ophthalmology billing services include
Full-cycle RCM for medical eye clinics, retina injection suites, and cataract/glaucoma surgery professional claims.
The operating cycle matches medical billing services: eligibility and prior auth, charge capture from exam and operative notes, ICD-10 / CPT / HCPCS coding, scrub, clearinghouse submission, payment posting, denial management, and A/R follow-up. The scrub watches eye-code vs E/M selection, medical vs vision benefit routing, refraction separation, diagnostic-test frequency and LCD diagnoses, injection drug units with JW/JZ, laterality, cataract and laser globals, and co-management modifiers when post-op care is shared.
In scope: comprehensive and intermediate ophthalmological exams (92002–92014) or E/M when documentation and payer rules fit, refraction (92015) routed to vision plan or patient responsibility, OCT / visual fields / fundus photography / angiography with interpretation, intravitreal injections (67028) plus anti-VEGF and related J-codes, cataract extraction with IOL (66982 / 66984), YAG capsulotomy, glaucoma lasers (e.g. SLT), MIGS and other surgical professional claims, and oculoplastics when medical necessity is documented. Dedicated optometry billing covers routine vision-benefit workflows when that is a separate account — medical ophthalmology stays here. ASC facility fees stay on the facility claim.
The fee is a percentage of net collections (flat or per claim in New York). The written rate is on pricing. Credentialing, a retrospective coding audit, MIPS, and out-of-network / IDR are separate engagements.
What this ophthalmology fee includes
- Exam, testing, injection, and surgery kept on the correct separate lines
- Drug units, globals, and vision vs medical routing scrubbed before age
- HIPAA workflows, a signed BAA, and PHI limited to staff on the account
Where ophthalmology claims fail
Common ophthalmology billing issues include an eye exam collapsed into the surgical claim, injection-drug units or authorizations that do not match the dose, and postoperative visits billed inside the global period.
Exam collapsed into surgery
Trying to carry the clinic eye exam and the operative procedure as one story. Or billing both an eye code and an E/M for the same encounter. Refraction left on the medical claim where Part B excludes it.
The eye exam and the surgical claim do not share one code.
Injection drug unit / auth gaps
67028 billed without the J-code, wrong unit math for dose, missing NDC, or JW/JZ omitted. Anti-VEGF given without current prior auth or step therapy. Laterality missing on per-eye lines.
Drug and injection are separate lines — units must match the vial documentation.
Global-period visits misbilled
Routine post-cataract visits billed inside the 90-day global. YAG timed inside an active same-eye cataract global without the correct unrelated-procedure logic. Second-eye surgery without 79 when required. Co-management 54/55 omitted when post-op care is shared.
Each eye’s global clock is tracked separately.
Exam · surgery · not one code
Eye exam and surgical claim — not one code
The clinic eye exam and the operating-room or surgery-center claim are billed separately.
Clinic encounters use ophthalmological service codes (intermediate 92002/92012 or comprehensive 92004/92014) or E/M (99202–99215) when documentation and the payer’s preference support E/M — not both for the same visit. Comprehensive eye codes require the documented elements and initiation or continuation of a diagnostic/treatment program.
When the patient goes to ASC or hospital for cataract, retina, glaucoma, or oculoplastic surgery, the professional surgical CPT is its own claim with place of service, laterality, and global period. Pre-op decision visits and unrelated problems in a global use 57 / 24 / 79 as documentation supports. The clinic eye exam from a different day is never “bundled into” the surgical code as a substitute for correct global tracking.
Same-practice checklist
- Eye code or E/M — pick one family per encounter
- Surgical CPT billed with correct POS and global clock
- Refraction routed off the medical claim when excluded
Medical eye care vs vision benefit
Disease work goes to medical insurance; refraction usually does not.
Medical diagnoses
Glaucoma, cataract, macular degeneration, diabetic retinopathy, and other disease-driven visits bill to medical insurance with specific ICD-10 (stage and laterality when required). A routine vision-plan visit that discovers disease is re-routed to medical — refraction still separates.
Refraction 92015
Medicare Part B generally excludes refraction. Bill the vision plan or collect from the patient. An ABN is not required for this statutory exclusion, though many practices use a voluntary notice so patients expect the charge. Do not let 92015 hold up or contaminate the medical claim.
OCT, fields, and imaging
Interpretation, medical necessity, and frequency — not automatic add-ons.
OCT
92133 (optic nerve) and 92134 (retina/posterior) need a signed interpretation and report and a supporting diagnosis. Do not bill both for the same structure the same day without payer support. Injection-day OCT is separately payable when it drives a distinct clinical decision.
Fields and photos
Visual fields (92081–92083), fundus photography (92250), and fluorescein angiography (92235) follow LCD frequency and diagnosis lists. Some payers bundle photos with comprehensive eye exams — check policy before stacking.
Technical vs professional
When imaging is performed in a facility, the professional interpretation may need modifier 26. Office-owned equipment usually bills the global service. Do not duplicate the facility technical component.
Intravitreal injections and anti-VEGF drugs
67028 per eye, plus the drug — units, NDC, and waste.
Procedure + drug
Bill 67028 with RT or LT (or payer bilateral rules). Bill the drug on its own line with the correct J-code and units for the dose administered (aflibercept, ranibizumab, faricimab, bevacizumab, and others as supplied). Report NDC. Use JW for discarded single-dose drug or JZ when none was discarded. Prior auth and step therapy are scrubbed before the injection is drawn.
Same-day exam / OCT
A separately identifiable exam or medically necessary OCT can bill the same day when documentation supports distinct work. Habit-stacking every injection with a comprehensive eye code and dual OCTs is a denial pattern. Allowed rates vs acquisition cost are reviewed before buy-and-bill commitments.
Cataract, lasers, and globals
90-day and 10-day clocks vary by code and by payer.
Cataract + IOL
66984 routine and 66982 complex carry Medicare 90-day globals. Routine related post-op visits are included. Second-eye surgery often needs 79. Co-management uses 54 (surgical care only) and 55 (post-op care only) when an optometrist or other clinician manages post-op. Premium IOL upgrades are typically patient-pay — not forced onto Part B as covered.
YAG and SLT
YAG capsulotomy (66821) and laser trabeculoplasty (65855) have payer-specific globals (often 90 vs 10 days — verify; commercial may differ from Medicare). YAG for PCO is usually outside the cataract global months later; inside an active same-eye global it needs careful unrelated-procedure logic. Laterality applies.
Unrelated E/M in global
Modifier 24 only when the exam is clearly unrelated to the surgery of that eye and the note says so. Related post-op complaints are included in the global.
Ophthalmology code families this service handles
These codes are examples. The note, laterality, and payer global decide the final claim.
Refraction
92015
OCT
92133 / 92134
Injection
67028 + RT/LT
Anti-VEGF drug
J-codes + NDC + JW/JZ
Cataract
66984 / 66982
YAG / SLT
66821 / 65855
Fields / photos
92081–92083 / 92250
Premium IOL
Patient responsibility
The free audit reads your exam/surgery split, injection units, and global clocks on the sample you send.
What a free audit line looks like
Illustrative composite only — not a client result and not a promised recovery.
Documented service
Right-eye aflibercept 2 mg intravitreal injection; 0 mg discarded; medically necessary OCT retina with I&R same day; auth current
Billed codes
67028-RT only; drug never charged; OCT omitted
Issue found
Highest-dollar J-code line left off; imaging not captured
Recommended correction
67028-RT + J-code units for 2 mg + JZ + 92134 with supporting Dx and signed report
Related check
NDC matches vial; step therapy / auth covers this agent and eye
Why it matters
Injection revenue is drug-driven — caught in scrub or flagged in the free audit
Request a Free Audit with recent notes, claims, and denials. We map exam, injection, and surgery lines on your file — not this composite.
How Vector runs ophthalmology billing
Benefit routing and globals first — then the same revenue cycle.
1
Assign ophthalmology
Coder and biller who already work eye vs E/M selection, injection units, and cataract globals.
2
Reconcile and code
Charge entry and coding from exam and operative records — queries when laterality or dose cannot be supported.
4
Post and report
835 posting, denial work, A/R aging, monthly RCM report by exam vs injection vs surgery.
Not inside the ophthalmology percentage
Related work stays separate so the quote matches the job.
ASC facility fees
Facility charges and implants billed by the ASC stay on the facility NPI. We bill the professional service your surgeons perform.
Credentialing / audit
Credentialing and a retrospective coding audit of injection units and globals are separate engagements when scoped.
Underpay / OON
Underpayment recovery and OON / IDR are handled separately when the dispute path is not ordinary denial work.
How ophthalmology billing is priced
Percentage of dollars that land — not a flat fee per injection that ignores drug-unit leaks.
Written rate
The fee is a percentage of net collections (flat or per claim in New York). No setup fee on the monthly cycle. Month to month. The written rate follows clinic, injection, and surgical mix and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
What we need to start
EHR access, monthly exam / injection / surgical census, top drugs and payers, open A/R if you are leaving another biller, and a sample of recent drug, OCT, or global-period denials. Switching usually overlaps so claim submission does not stop. See EHR integration if access setup needs a separate quote.
Audit the eye claims that bill the injection and lose the drug
Send monthly exam, injection, and surgical volume, top anti-VEGF agents, EHR name, and a sample of drug or global denials. We reply with what the open A/R shows, whether the monthly fee fits, and a written rate.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Ophthalmology billing questions
Answers on ophthalmology codes, payers, and fees.
Why outsource ophthalmology medical billing?
Ophthalmology keeps the eye exam and the surgical claim on different codes, routes medical eye care away from the vision benefit, and tracks each eye's global clock. Refraction is excluded by Part B, intravitreal anti-VEGF needs the J-code, correct unit math, the NDC, and JW or JZ, and cataract post-op visits inside the 90-day global are part of the package. A general desk collapses the exam into surgery or loses the drug on an injection day. A specialist team scrubs laterality, drug units, and globals.
How much does ophthalmology medical billing cost?
The fee is a percentage of what we collect for you, not of gross charges, so you pay on collected dollars across the clinic, injections, and surgery. New York practices can choose a flat monthly fee or a per-claim rate. There is no setup fee, the agreement is month to month, and the written rate follows your clinic, injection, and surgical mix after a free audit. See how pricing is set.
Do you bill ophthalmology for solo practices and groups nationwide?
We bill ophthalmology for solo ophthalmologists and for multi-location and surgical groups in all 50 states, tracking each eye's global inside the EHR you already use. The professional service is in scope; ASC facility and implant charges stay on the facility NPI. See all 50 states and solo practice billing.
What does ophthalmology billing include?
Medical eye exams, diagnostic testing, intravitreal injections with drug lines, cataract and laser surgical professional claims with global tracking, co-management when applicable, scrubbing, submission, posting, denials, and A/R.
How much do ophthalmology billing services cost?
The fee is a percentage of net collections (flat or per claim in New York). No setup fee on the monthly cycle. The written rate follows clinic, injection, and surgical mix and payer mix.
Do the eye exam and surgery share one code?
No. The eye exam and the surgical claim do not share one code. They are separate lines with different global and place-of-service rules.
Is refraction covered by Medicare medical benefits?
Generally no. 92015 is typically excluded from Part B and billed to a vision plan or the patient. Medical disease care bills separately to medical insurance.
How are anti-VEGF injections billed?
67028 per eye with laterality, plus the drug J-code with units, NDC, and JW or JZ. Auth and step therapy are confirmed before the dose.