Medical specialties
Primary and family care
Surgical and procedural
Dental, DME and labs
Revenue cycle · one rate
Front end · before the visit
Patients, insight and growth
Clinical documentation
Revenue operations
Voice automation
Ophthalmology billing services · Retina · Cataract · Optometry
PhysiAssist runs billing for ophthalmology and optometry practices. We bill every retina injection by the right drug code and unit, split premium cataract lenses correctly between Medicare and the patient, keep diagnostic testing within frequency limits, and send each visit to the medical or vision plan that should pay it.
Anti-VEGF units calculator
Try itDrug line
Injection
Waste
Label doses and HCPCS units; your physician's order rules
The basics
Ophthalmology billing services manage the revenue cycle of an eye care practice: eye exam and E/M coding, diagnostic testing, cataract surgery and premium lenses, intravitreal injections and drug units, step therapy and authorizations, optometry and vision plans, ASC claims, payment posting, denials and AR. In retina practices the drug lines carry most of the revenue and most of the risk.
Eye codes versus E/M, OCT, visual fields and fundus photos within frequency limits.
Standard and complex cataract, premium lens upgrades and ASC facility claims.
Anti-VEGF drug units, biosimilars, step therapy and bilateral billing.
Routine exams and materials to vision plans, medical visits to medical insurance.
What we check
| Codes | What they cover | What we check |
|---|---|---|
| 92002–92014 · 99202–99215 | Eye exam codes and E/M visits | Which set the record supports and which the payer pays |
| 92133 · 92134 · 92083 · 92250 | OCT optic nerve and retina, visual field, fundus photos | Diagnosis, frequency limits and same-day bundling |
| 66984 · 66982 | Cataract surgery, standard and complex | Complexity documented for 66982, and the global period |
| V2788 · V2787 | Presbyopia- and astigmatism-correcting lenses | Patient portion collected with a signed notice |
| 67028 | Intravitreal injection | RT, LT or 50 by payer, and the drug line for each eye |
| J0178 · J0177 · J2778 · J2777 · J0179 | Aflibercept, aflibercept HD, ranibizumab, faricimab, brolucizumab | Units from the dose, JZ or JW, step therapy and authorization |
| 92015 | Refraction | Collected as patient pay where Medicare does not cover it |
Free retina drug and testing audit
Send us a recent month of injection, drug and testing claims. A certified coder checks units, codes, modifiers and authorizations and sends a written report you keep.
Drug lines reviewed
420With an issue
31Dollar impact
$26,900What the report covers
Office, retina and surgery
Cataract surgery in an ASC, injections in the retina suite and exams in the clinic each follow different rules. We bill all of them, and the drug and lens decisions behind them.
The systems we work in every day
We log in to your system; nothing about it changes for your team.
Claims, rejections and remittances worked through your clearinghouse.
Submissions, status checks and renewals in each payer's own portal.
Pricing
One rate of 2.8% to 5% of net collections, quoted in writing before you sign. Where you land depends on monthly collections, specialty mix, the scope of services, and your AR backlog and payer mix.
The rate covers medical coding, claim submission, payment posting, denials and AR follow-up. Front desk services, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.
See full pricing and estimate your rate →Eligibility and prior authorization, coding of eye exams and E/M visits, diagnostic testing such as OCT and visual fields, cataract surgery with premium lenses, intravitreal injections and drug units, optometry and vision plan claims, ASC claims, payment posting, denials, AR follow-up and patient billing.
Either can be correct. Eye exam codes 92002 to 92014 and E/M codes 99202 to 99215 have different documentation rules, and payers pay them differently. We check which set the record supports and which the payer pays better, visit by visit.
The injection is billed with 67028 for each eye (RT or LT, or modifier 50 for Medicare when both eyes are injected), and the drug is billed by its HCPCS unit: aflibercept J0178 per 1 mg, aflibercept HD J0177 per 1 mg, ranibizumab J2778 per 0.1 mg, faricimab J2777 per 0.1 mg. Single-dose vials with nothing discarded carry JZ.
Medicare pays for standard cataract surgery and a standard lens. For a presbyopia-correcting or astigmatism-correcting lens, the patient pays the extra cost, billed with V2788 or V2787 and a signed notice before surgery, so the claim and the patient bill do not overlap.
Yes. We bill routine vision exams and materials to vision plans such as VSP and EyeMed, and medical eye care to medical insurance, and route each visit to the right plan.
Yes. Many plans require a lower-cost drug, such as bevacizumab or a biosimilar, before covering aflibercept or faricimab. We track each plan's rules and get approvals before the injection is scheduled.
PhysiAssist charges 2.8% to 5% of net collections for coding, claims, payment posting, denials and AR, quoted in writing before you sign.
We review recent injection, drug and diagnostic testing claims and send a written report: drug units and codes, JZ and JW lines, bilateral billing, step therapy and authorizations, testing frequency, denials by root cause and the dollar value of each.
A free retina drug and testing audit by a certified coder, with a written report you keep.