Ophthalmology Medical Billing & Credentialing Services

Specialized RCM Support for Eye Surgeons, Retina Specialists & Vision Care Clinics

Why Ophthalmology Billing Requires Specialized Knowledge

Ophthalmology blends both medical and surgical procedures, making it one of the most billing-intensive and audit-sensitive specialties. From complex eye surgeries and diagnostic imaging to routine eye exams and intravitreal injections, ophthalmology billing must distinguish between routine vision care and medically necessary treatment—a distinction that many payers scrutinize closely.

At Oakview Medical Billing Solutions, we deliver targeted billing, credentialing, and RCM support for ophthalmologists, retina specialists, oculoplastic surgeons, and optometric-ophthalmic hybrids. Our team is fluent in the nuances of CPT coding, modifier use, global periods, and the intricate payer policies that affect reimbursement.

Our Ophthalmology RCM Services Include:

Accurate CPT Coding & Modifier Usage

We ensure correct use of ophthalmic-specific CPT codes, like 92004, 92014, 67028, and surgical codes from 65435 to 68840.
We also manage:

• Modifier 25/59/RT/LT based on laterality and procedure bundling

• Global surgical period tracking for cataract and retinal procedures

• Diagnostic tests (e.g., OCT 92134, Visual Fields 92083) that require medical necessity documentation

Prior Authorization & Coverage Verification

We manage pre-authorizations for intravitreal injections (e.g., Lucentis, Eylea), glaucoma surgeries, and imaging services. Our team checks LCD/NCD rules and ensures timely authorization to avoid payment delays.

Surgical Billing Support

We bill for:

• Cataract surgery (66984, 66982)

• Retina procedures (67036, 67028)

• Corneal transplants, blepharoplasty, and laser vision correction

• Facility and professional fees with correct split-billing

Vision vs. Medical Claim Routing

We help practices distinguish and route claims properly:

• Routine vision exams (refraction codes like 92015) go to vision plans (e.g., VSP, EyeMed)

• Medical eye issues (e.g., diabetic retinopathy, glaucoma, dry eye) are routed to medical payers with appropriate diagnosis coding

Credentialing for MDs, DOs & ODs

We enroll ophthalmologists and optometrists with:

• Medicare, Medicaid MCOs

• Commercial carriers (UHC, BCBS, Aetna, Cigna)

• Vision plans (VSP, EyeMed, Spectera)

• Ambulatory Surgery Centers (ASC) and specialty retina networks

We maintain CAQH, NPI, DEA, state licenses, and track expiring credentials across all entities.

Performance Monitoring & Reporting

Custom monthly reports show:

• Clean claim % by payer

• AR aging by service line (surgical, imaging, injection)

• Denials by type (medical necessity, prior auth, duplicate billing)

CPT Codes Frequently Used in Ophthalmology

Why Eye Specialists Choose Oakview

• Eye-Specific Coders trained in ophthalmology claim structures

• Payer Audit Defense with modifier optimization and documentation reviews

• Vision Plan Integration for dual medical-vision workflows

• Faster Payer Enrollment with ASC and retina-specific contracts

• Denial Recovery & Appeals including prior auth reversals and LCD exceptions

Who We Support

• Comprehensive ophthalmology clinics

• Retina-focused surgical groups

• Solo and group optometry practices

• LASIK and refractive surgery centers

• Oculoplastics and orbital specialists

• Pediatric and neuro-ophthalmologists

• ASC and hospital-affiliated practices

Ready to Simplify Your Eye Care Billing?

Let Oakview handle the complex, ever-changing landscape of ophthalmology billing and credentialing—so you can stay focused on preserving vision, not chasing payers.

Reach out now for a no-cost consultation and RCM audit.