Ophthalmology Medical Billing and Coding Services
Ophthalmology billing is particularly complex. From eye-specific CPT codes and global surgery periods to laterality modifiers and payer-specific rules, small errors can delay payments or trigger denials.
Preferred MB delivers expert ophthalmology medical billing and coding services that streamline your claims, reduce denials, and ensure revenue integrity. Our certified ophthalmic coders and billers operate with precision across clinical, surgical, and diagnostic eye care revenue cycles.
- 20–25% reduction in ophthalmology claim denials
- 95 %+ first-pass clean claim rate
- 25-30 day average AR cycle
Stop Ophthalmology Revenue From Slipping Through the Cracks
Even top eye care practices lose revenue to small but recurring mistakes. These leakages often hide in documentation gaps, improper modifier use, or subtle payer rules.
Where Ophthalmology Revenue Disappears
- Laterality (LT/RT) modifier errors for bilateral eye services
- Global surgery charges not separated or bundled improperly
- Intravitreal injection J-code misreporting
- Under-documented evaluation & management (E/M) visits vs eye codes
- Claims denied for missing prior authorization or missing medical necessity
- Delays from submitting diagnostic codes (ICD) that do not support procedures
Preferred MB proactively audits your ophthalmology claims, tracks payer edits in real time, and intervenes to reclaim missed revenue.
Incorrect laterality or bilateral modifiers
Global period bundling miscalculations
Uncaptured injections or drug billing errors
Documentation that fails to support combined E/M + surgery
Payer-specific rules for eye care (e.g. MAC, LCDs)
Ophthalmology Billing Services Across Your Full Revenue Cycle
We mirror your practice workflow from clinical capture to final payment — converting complexity into clarity.
Capture Detailed Documentation
We help your team record diagnostic assessments, eye test results, imaging, injections, and surgical planning accurately to support billing demands.
Submit With Precision
Every claim is validated — CPT, ICD, modifiers, laterality, global periods — and scrubbed for payer-specific logic before submission.
Monitor EHR & System Integration
We integrate with your ophthalmology EHR or practice management software to flag errors or missing information early.
Track Every Claim
Claims are systematically scored by visit type and payer. Auto-flagging occurs for missing modifiers, incomplete documentation, or denial risk.
Resolve Denials Quickly
We deploy specialty templates and appeals logic (e.g., MAC, LCD, local coverage, global surgery appeals) to correct and resubmit denials fast.
Manage AR Intelligently
Ophthalmology AR is segmentation by payer, surgical vs medical, and aging bucket, focusing on high-value accounts within 30 days.
Overlooked Billing Gaps in Ophthalmology Practices
Routine audits across eye care groups reveal recurring issues that often go unnoticed but cost thousands monthly.
- 30 percent of cataract procedure claims include invalid global period coding
- 25 percent of injection claims have missing or incorrect J-codes
- 40 percent of diagnostic imaging services remain under-documented
- $1 000 to $2 000 monthly per provider lost from unbilled post-op visits
- 35 percent of ophthalmology denials go unappealed
- 22 percent of AR remains open beyond 45 days
Preferred MB identifies these missed opportunities using automated audits and payer-specific correction logic.
Is Your Ophthalmology Revenue Fully Protected?
Use this 5-point checklist:
Subspecialty Ophthalmology Billing. Zero Errors. Full Reimbursement.
Preferred MB aligns ophthalmology billing with real clinical documentation to achieve full reimbursement across diagnostic, medical, and surgical eye care.
Clinical Scenario
A patient undergoes cataract extraction with intraocular lens implantation followed by post-operative checkups within the global period.
- Pre-op exam documented with IOL power calculation
- Surgery note linked with operative details and modifiers
- Post-op visits recorded under correct global tracking
Billing Scenario
Preferred MB applies global period logic and validates modifier 55 or 79 usage.
- Pre- and post-operative visits separated correctly
- Bilateral procedures coded with modifier 50 validation
- Surgical and diagnostic charges aligned with payer rules
Clinical Scenario
Patient treated for diabetic macular edema with intravitreal injection of Eylea.
- Drug lot and NDC recorded in EHR
- OCT results attached to progress note
- Follow-up visit scheduled under same diagnosis
Billing Scenario
Preferred MB ensures drug and injection coding accuracy.
- J-codes verified with current NDC and HCPCS updates
- Medical necessity linked to diagnosis code
- Modifiers applied for multiple same-day injections
Clinical Scenario
Patient with primary open-angle glaucoma undergoes selective laser trabeculoplasty with follow-up IOP monitoring.
- Procedure details documented with laterality
- Visual field results stored in record
- Post-laser follow-up plan entered
Billing Scenario
Preferred MB validates CPT selection and global tracking.
- Modifiers 24 and 79 reviewed for post-op claims
- Visual field and IOP tests paired with diagnosis
- Prevents denials from global overlap
Clinical Scenario
Corneal transplant performed with eyelid reconstruction after trauma.
- The surgery report includes the tissue source and the operative time
- Photographs added to documentation
- Post-surgical medication plan logged
Billing Scenario
Preferred MB captures every reimbursable element.
- CPT 65730 or related codes applied with correct modifiers
- Unbundling validated for separate oculoplastic work
- Compliance review prevents duplicate billing errors
Clinical Scenario
Patient evaluated for glaucoma with OCT and visual field testing in same visit.
- OCT image interpretation signed by provider
- Visual field results attached to the clinical note
- Assessment and plan documented in the chart
Billing Scenario
Preferred MB codes imaging and interpretation precisely.
- CPT 92133 and 92083 linked to diagnosis
- Modifier 59 applied where multiple tests were performed
- Payer frequency limits validated before submission
How Preferred MB Handles Ophthalmology Billing Differently
| Stage | Traditional Billing Approach | Preferred MB Approach |
|---|---|---|
| Claim Review | Processed in bulk with limited subspecialty oversight. | Reviewed by certified ophthalmic coders with specialty-specific accuracy. |
| Coding Validation | Generic coding logic used. Laterality and global periods often missed. | Automated logic validates CPT, ICD, modifiers, and global period alignment. |
| Documentation Check | Errors found post-submission or during payer audits. | EHR-integrated audits flag missing notes, NDCs, or diagnostics before submission. |
| Claim Submission | Claims sent without payer-specific customization. | Each claim scrubbed for payer rules and frequency limits before sending. |
| Denial Management | Denials handled reactively after payment delay. | Proactive monitoring identifies risks and resolves denials within 5 business days. |
| Accounts Receivable (AR) | Aged claims are tracked manually with limited visibility. | AR segmented by payer and procedure type for focused follow-up. |
| Reporting | Generic monthly reports with minimal insights. | Real-time dashboards show denial causes, payer trends, and recovery metrics. |
Reclaim Every Dollar of Your Ophthalmology Revenue
Partner with Preferred MB to eliminate billing errors, stop denials before they occur, and achieve full reimbursement accuracy. Our certified ophthalmic billing team aligns every claim with real clinical documentation and payer logic to protect your revenue from leakage.