Original Medicare usually excludes routine eye exams and glasses, yet covers medical eye care, glaucoma screening for high-risk patients, and cataract surgery. Every visit has to land in the right lane before the claim goes out. Glaucoma, cornea, and pediatric work each add their own wrinkles.
Book a demoGeneral ophthalmology and its subspecialties share a schedule but not one set of rules.
Original Medicare usually does not cover routine vision exams, while visits for an eye disease or injury can be billed with eye exam or E/M codes. Refraction is a common patient-pay item even inside a covered visit, so the front desk needs a clear policy.
Medicare covers an annual glaucoma screening for patients in defined high-risk groups, billed with G0117 or G0118 and a screening diagnosis. Patients already diagnosed with glaucoma are followed with medical visits and diagnostic tests instead, each with its own documentation.
Cataract and corneal surgery generally carry 90-day global periods. When an optometrist handles post-operative care, Medicare splits the package with modifiers 54 and 55, and both claims must match on code and date of service.
Many eye practices also run an optical shop, which is a different business with different payers.
Clinicians document the reason for each visit and test, interpret diagnostic imaging, and approve drafted codes. Frames, lenses, and optical sales stay with your optical team.
Medical eye care claims: eligibility checks, scrubbing, submission, and every denial and appeal, including small-dollar testing denials. Patient statements and follow-up come with it.
Routine vision plan claims, glasses or contacts after cataract surgery, and injectable drugs each follow separate rules. Agree on which of these come into scope before onboarding.
Bring de-identified examples from each subspecialty you want covered. Keep patient details out of the booking form.
Break out general, glaucoma, cornea and external disease, and pediatric visits with rough volume for each. Pediatric patients often carry Medicaid or CHIP, where each state sets vision benefits and authorization rules.
List co-management partners, how transfer-of-care agreements are documented, and who bills the post-operative portion.
Explain how you collect for refractions and whether you bill vision plans. Those workflows shape what your front desk keeps.
Useful to an independent ophthalmology practice whose glaucoma testing, cataract, cornea, or pediatric claims keep stalling on frequency limits, modifiers, or eligibility, and that wants coding and appeals handled without changing its EHR.
Post-cataract eyewear goes to Medicare's DME contractors, and injectable drugs follow their own billing rules. This page does not determine coverage or codes for any eye service.
Yes, once a year for Part B patients in defined high-risk groups, such as people with diabetes or a family history of glaucoma. The deductible and coinsurance still apply.
Original Medicare does not cover refraction, even during a covered medical visit, so many practices collect for it separately. Other payers set their own rules.
The surgeon bills the surgical portion with modifier 54 and the optometrist bills post-operative care with modifier 55, using the same procedure code and date of service. A written transfer agreement belongs in the record.
No. Taiga works alongside your existing EHR, and onboarding takes about two weeks to first claim.
Share a week of visit types, your co-management setup, and recent denials. Taiga will tell you what it could own and how onboarding would run.
System guides show possible billing handoffs, not proven specialty compatibility.