Improve Optometry Medical Billing Collections

An optometry practice has also the same agenda as other small businesses – you want to succeed. To achieve success in business is one that focuses on growing revenue while providing excellent experiences to their customers. Here, customers are patients. Improving optometry medical billing collections is a vital strategy to achieve financial stability.

Suggestions to Improve Optometry Medical Billing Collection:

Verification with the Insurance Payer

One of the initial steps in optometric medical billing is to ensure that the provider has been credentialed by the insurance company.

You need to make sure to submit and track credentialing applications based on the insurance plan requirement. Take your application one step further and follow up with insurance payers regularly to ensure that the providers are enrolled in the network whenever enrolment is open.

Read more: The time has come to get credentialed first!

Correct use of Modifiers

Many optometrists use to bill a CPT® code 92133/92134 and fundus photography – CPT® code 92250 on the same visit. If you do not code this correctly then Medicare may deny both codes or only allow payment on the code with the lowest reimbursement.

92133 and 92134 are subject to Medicare’s Multiple Procedure Payment Reduction (MPPR). This reduces the allowable for the technical component of the lesser-valued test when more than one test is performed on the same day.


CPT® codes are published by the American Medical Association® and consist of three types or categories of five-character codes and two-character modifiers to describe any changes to the procedure.

NCCI edits prevent bundling/unbundling due to incorrectly using CPT® procedure codes and HCPCS billing codes, including combining inappropriate code combinations. A revised annual version of the National Correct Coding Initiative Policy Manual for Medicare effective January 1, 2021, was posted December 18, 2020.

While the NCCI edits do permit the use of a modifier for OCT/GDX and fundus photography, be cautious and use a modifier properly, or it may result in a denial or rejection. It depends on local policies, if tests are necessary due to 2 separately recognizable conditions, you may be able to link the suitable diagnosis code to each CPT® and addition of modifier 59 to the second procedure.

Stay Updated

To make sure you are coding your eye care claims properly and error-free, you must remain careful with Local Coverage Determinations (LCD) and Medicare Administrative Contractors (MAC) in your area and sign up to receive payer listserv updates.

Doctors of optometry and their staff need to be prepared for substantial changes in 2021 to optometry coding and documentation for evaluation and management (E/M) services. Starting Jan. 1, 2021, E/M codes will need to be selected based on what is more appropriate: medical decision-making or total time, not a patient’s history and physical.

Use an ABN for Non-Covered Services

If you are unsure that the procedure or service you will provide to the patient may not be covered by commercial non-Medicare plans or original Medicare and the patient may be responsible for out-of-pocket costs, get an Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. In this case, the patient must sign the ABN before you provide the procedure or service to the patient.

Do you have a lot of paperwork burden? Keeping up to date with confusing and never-ending optometry and ophthalmology billing rules and regulations, payer requirements and complicated EDI processes, and managing denials and rejections is time-consuming.

Ready to outsource to a leading medical billing company? You will see increased ROI when you outsource eye care billing to Medical Billers and Coders (MBC). We will help you to get started. Reach out to us today, we are just one form submission away.