Ophthalmology Billing Services
Ophthalmology billing combines high-volume office procedures with complex surgical coding for cataracts, retinal procedures, and glaucoma surgery. IOL implant billing and optical coherence tomography add additional coding layers.
Why Ophthalmology Billing Requires Specialty Expertise
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.
Common Ophthalmology CPT Codes
Our coders handle these ophthalmology codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Ophthalmology CPT Codes by State
Medicare reimbursement for ophthalmologyprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same ophthalmology CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 10 core ophthalmologycodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Ophthalmology Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 92014 | Comprehensive eye exam, established patient | $142.73 | $126.21 | $128.79 | $139.06 | $126.17 | $125.99 | $120.44 | $123.98 | $121.52 | $123.02 |
| 92012 | Intermediate eye exam, established patient | $101.93 | $89.70 | $91.66 | $99.13 | $89.66 | $89.55 | $85.41 | $88.06 | $86.22 | $87.34 |
| 92004 | Comprehensive eye exam, new patient | $167.24 | $148.52 | $151.19 | $163.11 | $148.49 | $148.11 | $142.03 | $145.97 | $143.29 | $144.84 |
| 66984 | Cataract extraction with intraocular lens insertion | $500.51 | $459.46 | $480.36 | $504.15 | $461.80 | $472.95 | $444.90 | $457.08 | $442.35 | $457.44 |
| 67028 | Intravitreal injection | $125.92 | $113.24 | $117.92 | $125.14 | $113.60 | $115.59 | $108.71 | $112.09 | $108.63 | $111.84 |
| 92250 | Fundus photography with interpretation | $41.52 | $36.74 | $37.79 | $40.64 | $36.76 | $36.94 | $35.05 | $36.15 | $35.27 | $35.92 |
| 92235 | Fluorescein angiography | $188.06 | $160.29 | $163.42 | $179.60 | $159.78 | $158.39 | $150.39 | $156.18 | $152.89 | $154.22 |
| 92133 | Optical coherence tomography (OCT) of optic nerve | $34.45 | $30.43 | $31.43 | $33.76 | $30.45 | $30.70 | $28.99 | $29.95 | $29.14 | $29.78 |
| 92134 | Optical coherence tomography (OCT) of retina | $36.78 | $32.41 | $33.43 | $35.97 | $32.43 | $32.64 | $30.85 | $31.88 | $31.04 | $31.68 |
| 65855 | Trabeculoplasty by laser surgery | $271.35 | $243.34 | $252.92 | $268.99 | $244.01 | $247.80 | $233.35 | $240.63 | $233.44 | $239.94 |
Full Ophthalmology fee detail by state
2026 Medicare allowables for ophthalmology CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 92014 | Comprehensive eye exam, established patient | $142.73 | $65.66 |
| 92012 | Intermediate eye exam, established patient | $101.93 | $43.83 |
| 92004 | Comprehensive eye exam, new patient | $167.24 | $82.27 |
| 66984 | Cataract extraction with intraocular lens insertion | $500.51 | $500.51 |
| 67028 | Intravitreal injection | $125.92 | $80.07 |
| 92250 | Fundus photography with interpretation | $41.52 | $41.52 |
| 92235 | Fluorescein angiography | $188.06 | $188.06 |
| 92133 | Optical coherence tomography (OCT) of optic nerve | $34.45 | $34.45 |
| 92134 | Optical coherence tomography (OCT) of retina | $36.78 | $36.78 |
| 65855 | Trabeculoplasty by laser surgery | $271.35 | $183.61 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Ophthalmology Billing Challenges We Solve
Common billing problems in ophthalmology and how our team handles them.
Cataract Surgery Global
90-day global includes post-op visits. Complications outside the global can be billed separately.
Intravitreal Injection Coding
67028 for the injection plus J-code for the drug. High-dollar drug billing requires correct units.
Diagnostic Testing Frequency
OCT and visual field testing have payer frequency limits.
Bilateral Procedures
Many ophthalmic procedures are bilateral with specific modifier rules.
Common Ophthalmology Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Ophthalmology Practices Miss
Payer-Specific Ophthalmology Billing Tips
Ophthalmology Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert Ophthalmology Billing Support
Free billing assessment for your ophthalmology practice. See where revenue is leaking.
What We Handle for Ophthalmology Practices
Why Choose Go Medical Billing for Ophthalmology
Ophthalmology billing requires managing surgical globals, high-dollar drug billing, and diagnostic testing frequency limits. Our team handles all of it.
We serve ophthalmology practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Ophthalmology Billing by State
We handle ophthalmology billing in all 50 states. The 2026 Medicare allowables for ophthalmology CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert Ophthalmology Billing Support
Stop losing revenue to ophthalmology coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.