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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.

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All 50 States
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HIPAA Compliant
AAPC Certified
4.9/5 Rating
300+ Practices
66984Cataract
67028Intravitreal Inj
92134OCT
65855Glaucoma

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.

Code
Description
66984
Cataract
67028
Intravitreal Inj
92134
OCT
65855
Glaucoma

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.

!
90-day global includes post-op visits
!
67028 for the injection plus J-code for the drug
!
OCT and visual field testing have payer frequency limits
!
Many ophthalmic procedures are bilateral with specific modifier rules

Revenue Opportunities Most Ophthalmology Practices Miss

Ophthalmology practices generate significant revenue from intravitreal injections (67028) for conditions like macular degeneration, diabetic macular edema, and retinal vein occlusion. Each injection generates a procedure code plus a high-cost drug code. With Eylea at $1,850 per injection and patients receiving injections every 4 to 8 weeks, a retina practice's injection revenue can exceed $2 million annually. Proper J-code billing with correct units ensures full drug reimbursement. Diagnostic testing frequency optimization is the second opportunity. OCT, visual fields, and fundus photography are recurring tests that support disease management. Billing them at the maximum frequency each payer allows maximizes diagnostic testing revenue.

Payer-Specific Ophthalmology Billing Tips

Medicare covers cataract surgery with IOL at standard rates, but premium IOL lenses (toric, multifocal, extended depth of focus) involve patient out-of-pocket charges above the Medicare-covered amount. Practices must clearly communicate the out-of-pocket cost and obtain written patient consent. Retinal drug (anti-VEGF) coverage is generally good across all payers, but biosimilar substitution policies are changing rapidly. Some payers now mandate biosimilar anti-VEGF agents as first-line, requiring step therapy documentation to use branded products. We track each payer's biosimilar policies.

Ophthalmology Billing Best Practices

Practical tips from our coding team to maximize reimbursement and minimize denials.

1
Cataract surgery (66984) has a 90-day global period. Post-op visits within this window are included. But if a complication arises (wound leak, CME, endophthalmitis), the additional care is separately billable.
2
Intravitreal injection (67028) drug costs are the biggest revenue component. Bill the correct J-code with exact units: Eylea (J0178) per 1mg, Lucentis (J2778) per 0.1mg.
3
OCT (92134) frequency limits vary by payer — Medicare allows every visit for retinal disease management, but some commercial payers limit to 1-2 per year without prior auth.
4
For bilateral procedures (cataracts on both eyes), bill the first eye with no modifier and the second eye with modifier 50 or on a separate line with modifier RT/LT.

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What We Handle for Ophthalmology Practices

Cataract surgery billing (66984) with IOL coding
Intravitreal injection and drug billing
OCT and diagnostic testing coding
Glaucoma surgery billing
Retinal procedure coding
Global period management for ophthalmic surgery

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. Select your state for location-specific payer details, Medicaid rules, and Medicare MAC policies.

CaliforniaTexasFloridaNew YorkPennsylvaniaIllinoisOhioGeorgiaNorth CarolinaMichiganNew JerseyVirginiaMassachusettsArizonaTennesseeMarylandIndianaMissouriWisconsinColorado
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Related Resources

Medical Billing & Coding ServicesA/R Recovery ServicesCredentialing & ContractingCase Studies & ResultsPricing

Frequently Asked Questions

Complete coding including procedure, IOL implant, and 90-day global period management with correct billing for complications.
Yes. 67028 for administration plus correct J-code and drug units.

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Stop losing revenue to ophthalmology coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.

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