Optometry billing for vision plans and medical eye care.
Optometry practices bill two very different kinds of insurance: routine vision plans and medical health plans. Choosing the wrong one, or the wrong code set, is one of the most common reasons eye-care claims are denied.
MediFier routes every visit to the right plan with the right codes, and follows up until it's paid.
- Routine Eye Exams
- Medical Eye Care
- Contact Lens Services
- Dry Eye & Glaucoma
- Pediatric Optometry
- Optical Sales
Optometry
Routine vision or medical? It changes everything.
A routine exam for glasses goes to the vision plan. An exam for a medical complaint or condition, such as diabetes, glaucoma or an eye infection, goes to the medical plan, often with eye-exam codes or E/M codes depending on the documentation.
Refractions, contact lens fittings and materials each have their own coverage rules. We sort it out before the claim goes out.
- Vision vs. medical plan selection
- Refraction coverage
- Contact lens fitting rules
- Materials and frame allowances
How MediFier supports optometry practices
Dual eligibility checks
Vision and medical coverage verified so each visit goes to the right plan.
Eye-care coding
Eye exam codes (92002–92014) or E/M codes chosen to match documentation.
Medical eye care
Glaucoma, diabetic eye exams and dry-eye treatment billed to medical plans.
Materials billing
Frames, lenses and contact lenses billed against plan allowances.
Plan credentialing
Enrollment with vision plans and medical plans for every provider.
Denial follow-up
Wrong-plan and non-covered denials corrected and resubmitted quickly.
Codes, rules and payers we work with every day
Our billers and coders are trained in optometry documentation and payer requirements, so claims go out right the first time.
See How We WorkOptometry questions, answered
How do you decide whether to bill the vision or medical plan?
We look at the reason for the visit and the documentation. Routine exams go to the vision plan; visits for medical complaints or conditions go to the medical plan.
Is refraction covered by medical insurance?
Often it isn't. We check coverage in advance so your team can collect for refraction when the plan excludes it.
Do you bill frames, lenses and contacts?
Yes. We bill materials against each vision plan's allowances and track patient overages.
Can you credential us with vision plans?
Yes. We handle enrollment with both vision plans and medical insurers.
The services optometry practices rely on most
Medical Billing
Clean claims, relentless follow-up and transparent reporting that turn your charges into cash faster.
Learn MoreEnrollment & Credentialing
Get in-network faster with end-to-end payer enrollment, CAQH management and re-credentialing.
Learn MoreVirtual Medical Scribe
Trained remote scribes chart every encounter in real time so your notes are done when your day is.
Learn More