Ophthalmology Billing Services in New York
New York's ophthalmology practices face unique billing challenges shaped by Empire BlueCross BlueShield's commercial rules, NY Medicaid Managed Care requirements, and Novitas Solutions Medicare policies. Our AAPC-certified coders specialize in both NY payer rules and ophthalmology coding complexity.
Why New York Ophthalmology Practices Need Specialized Billing
New York's healthcare market includes 90,000+ physicians, and ophthalmology practices here face a payer market dominated by Empire BlueCross BlueShield on the commercial side and NY Medicaid Managed Care on the public payer side. Medicare claims are processed through Novitas Solutions, which applies its own Local Coverage Determinations that directly affect ophthalmology procedure coverage and medical necessity requirements. Generic billing teams without NY specific knowledge leave revenue on the table.
Ophthalmology billing itself is complex. Ophthalmology practices perform high-volumes of diagnostic testing (OCT, visual fields, fundus photography), office procedures (intravitreal injections), and surgery (cataract, glaucoma, retinal). Cataract surgery billing includes the procedure, IOL implant, and post-operative visits within the global period. When you combine this coding complexity with New York's specific payer rules, authorization requirements, and 6 NY Medicaid Managed Care managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving ophthalmology practices from New York City to Albany and across New York.
Top CPT Codes for Ophthalmology in New York
Our NY coders handle these ophthalmology codes daily, applying Novitas Solutions Medicare rules and Empire BlueCross BlueShield commercial policies to each claim.
New York Payer Challenges for Ophthalmology
Every NY payer has specific rules for ophthalmology claims. Here's how we navigate them.
Empire BlueCross BlueShield Ophthalmology Claims
Empire BlueCross BlueShield processes the largest share of New York commercial ophthalmology claims. We know their NY specific fee schedules, prior authorization requirements for ophthalmology procedures, and their appeal timelines when claims are denied. 90-day global includes post-op visits. Complications outside the global can be billed separately.
NY Medicaid Managed Care Ophthalmology Billing
NY Medicaid Managed Care routes ophthalmology patients through 6 managed care plans: Fidelis Care, Healthfirst, MetroPlus, and 3 more. Each MCO has its own ophthalmology authorization and billing rules that we manage.
Medicare (Novitas Solutions) Ophthalmology Coverage
Novitas Solutions processes Medicare ophthalmology claims in New York with its own Local Coverage Determinations. We navigate Novitas Solutions's policies around intravitreal injection coding to prevent medical necessity denials.
Denial Prevention for New York Ophthalmology
Common ophthalmology denials in New York include 90-day global includes post-op visits and 67028 for the injection plus j-code for the drug. Our team catches these issues before submission and appeals aggressively with NY payer-specific documentation when denials occur.
Get Expert Ophthalmology Billing in New York
Free billing assessment for your NY ophthalmology practice. See where revenue is leaking.
What We Handle for New York Ophthalmology Practices
New York Ophthalmology Billing Cost Comparison
Hiring an in-house biller with ophthalmology expertise in New York costs $45K-$62K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified ophthalmology coders and NY payer specialists for a fraction of that cost.
$45K-$62K
In-House Biller Salary
+ benefits, software, space
2.49%
Go Medical Billing Rate
Full team, all services included
60-80%
Typical Cost Reduction
With better results
Related Pages
Explore our New York and ophthalmology billing resources.
Frequently Asked Questions
Fix Your New York Ophthalmology Billing
Call 888-701-6090 for a free billing assessment specific to your NY ophthalmology practice. We'll show you where revenue is leaking and how to fix it.