What we do
Eye Care Billing Services
Outsource the full revenue cycle or only the steps that are slipping. As an ophthalmology medical billing company, we run every service with billers who work only on eye care claims.
Revenue Cycle Management
Claims stalling between front desk and bank? We run every revenue step as one tracked workflow.
Learn moreMedical Coding
Exam levels, modifiers or laterality causing denials? Eye care coders check each claim before it goes out.
Learn moreProvider Credentialing
New doctor waiting on payer approval? We file Medicare, commercial and vision plan enrollments in parallel.
Learn moreEligibility and Prior Auth
Surprise denials for coverage or missing approvals? We verify benefits and authorizations before the visit.
Learn moreCharge Entry and Posting
Short payments slipping through unnoticed? We post every ERA against contract rates and flag the gaps.
Learn moreDenial Management
The same denials coming back every month? We appeal each one and fix the step that caused it.
Learn moreA/R Recovery
Claims aging past 90 days? We work old balances by value and filing deadline until they close.
Learn morePatient Billing
Patient balances going unpaid? We send clear statements, friendly reminders and payment plans.
Learn moreFee Schedule Review
Unsure if payers pay what they owe? We compare every contract with 2026 Medicare rates.
Learn moreSpecialties
Ophthalmology Billing for Every Eye Care Specialty
Each subspecialty has its own claim risks, from drug units in retina to global periods in cataract surgery. Optometry practices use us as their optometry billing company for medical and vision plan claims.
Find the Eye Care Revenue You Are Missing
Get a free, written review of your claims, denials and A/R within 10 business days.
Why us
Where Do Most Ophthalmology Billing Companies Fall Short?
General billing vendors treat eye care like any other specialty. These four habits are where specialist billing earns its fee.
Eye care only
Our team bills ophthalmology and optometry claims every day, nothing else.
Two payer systems
Medical insurance and vision plans handled in one workflow.
Audit-safe coding
Modifier 25 and complex cataract claims get a second review.
Clear monthly reporting
Net collection rate, A/R days and denials, pulled from your own system.
Pricing
What an Ophthalmology Billing Company Costs?
Ophthalmology billing companies charge a percentage of collections, typically between 3% and 8%. The Healthcare Billing and Management Association puts surgical specialties in a 3.5% to 7.5% range.
Our rate starts at 2.49% of collections, with no setup fee and no minimum monthly charge. Credentialing is priced separately per provider per payer, because volume varies too widely to fold into a percentage.
In-house billing team
Two full-time billers
- Salaries (2 × $62,000)$124,000
- Benefits and payroll taxes (25%)$31,000
- Training, cover and turnoverExtra
SP Ophthalmology Billing
Full eye care billing team
- Rate at $100,000 a month2.49%
- Setup fee$0
- Minimum monthly charge$0
A percentage model aligns us with you. We only earn when your claims get paid, which is the opposite of a per-claim fee that pays the same whether a claim collects or denies. Figures are an illustration, not a quote. See full pricing
Two payer systems
Medical and Vision Plan Billing in One Team
Medical insurance pays for disease and testing. Vision plans pay for routine exams and eyewear. Here is how common visits are routed.
| Encounter | Usual payer | Typical codes |
|---|---|---|
| Routine exam, no medical diagnosis | Vision plan | 92004 or 92014 (or S0620, S0621), 92015 |
| Glaucoma suspect follow-up with OCT | Medical insurance | 92012 or 99213, 92133 |
| Diabetic eye exam with retinopathy | Medical insurance | 92014 or 99214, 92250 or 92134 |
| Frames, lenses and contact lenses | Vision plan | V2020, V2100 to V2799 |
| Injection for wet AMD | Medicare Part B | 67028 with the drug J-code |
- Medicare
- Medicaid
- Medicare Advantage
- UnitedHealthcare
- Aetna
- Cigna
- BCBS
- Humana
- VSP
- EyeMed
- Davis Vision
- Spectera
Getting started
How Does Onboarding With Our Eye Care Billing Team Work?
Most practices switch in 30 to 45 days, with no gap in claim submission.
- Free billing auditWe review 90 days of claims, denials and A/R and send written findings within 10 business days.
- Agreement and accessWe sign a HIPAA BAA and get user access to your EHR, PM system and clearinghouse.
- Payer set-upWe confirm enrollment, ERA and EFT for every payer and load your fee schedules.
- Go-liveWe take over new claims, work open A/R in parallel and send the first KPI report at 30 days.
2026 update
2026 Medicare Changes for Eye Care
The 2026 fee schedule raised the conversion factor but cut most surgical codes through a new efficiency adjustment. Eye exam codes were exempt.