MedCare Billing Solutions provides expert ophthalmology medical billing for comprehensive ophthalmologists, cataract surgeons, retina specialists, glaucoma specialists, and optometrists. We understand the unique split between medical and routine vision billing, surgical global periods, and the complex HCPCS drug codes for ophthalmic injections — so you collect every dollar you've earned.
Ophthalmology is uniquely split between medical eye care (billed to medical insurance) and routine vision care (billed to vision plans). Getting this wrong on either end causes immediate denials. On top of that, surgical and injection billing involve extremely high-value claims with strict rules. Common costly errors include:
Ophthalmology practices bill two completely separate insurance systems — medical and vision. Submitting to the wrong payer type is the single biggest source of ophthalmology denials. MedCare's ophthalmology billers know exactly which diagnoses and services route to which payer — every time.
Our coders are trained across the full scope of ophthalmic surgery, diagnostics, and intravitreal injection drug billing.
| CPT / HCPCS | Procedure / Service | Common Billing Issue |
|---|---|---|
| 66984 | Cataract extraction with IOL implant (routine) | Global period management; premium IOL upgrade billing (V2787); bilateral -50 modifier |
| 66982 | Cataract extraction, complex | Using 66984 when 66982 complexity criteria are met — significant underpayment |
| 67028 | Intravitreal injection of pharmacologic agent | Drug J-code not billed separately (J0178/J2778/J0179); missing -RT/-LT modifier |
| J0178 | Aflibercept (Eylea) per 1mg | Dose calculation errors; wrong J-code for concentration administered |
| 92134 | OCT — retina (scanning computerized ophthalmic) | Bundled incorrectly with exam; missing -26 when performed in ASC |
| 92083 | Visual field examination, extended | Simple (92081) vs. extended (92083) miscoded; missing diagnostic report |
| 66170–66172 | Trabeculectomy (glaucoma filtering surgery) | With vs. without antimetabolites code selection; global period overlap |
| 92004 / 92014 | Comprehensive eye exam (new/established) | Used for medical visits when E/M codes (99213-99215) are more appropriate |
We correctly route every encounter to the right payer — medical insurance for disease-based care and vision plans for routine exams — eliminating your #1 source of denials.
Complete cataract billing including standard vs. complex surgery coding, premium IOL upgrade fees, global period management, and bilateral procedure modifiers.
Precise anti-VEGF drug HCPCS coding (Eylea, Lucentis, Avastin, Vabysmo) with correct dosage units and laterality modifiers — protecting your highest-value retina claims.
Separate billing for OCT, visual field testing, fundus photography, corneal topography, and fluorescein angiography — all with correct -26/-TC modifiers.
Subspecialty-specific billing for glaucoma surgery (trabeculectomy, tube shunt, SLT) and retina procedures (vitrectomy, retinal detachment repair, laser photocoagulation).
We coordinate both professional (surgeon) and ambulatory surgery center (ASC) billing, ensuring the facility and professional claims are aligned and no revenue is missed.
Get a free ophthalmology billing audit. We'll analyze your medical vs. vision routing, cataract global periods, intravitreal injection drug billing, and diagnostic test capture — and show you exactly what you're leaving behind.