Who we serve · Optometry
Optometry practices with a medical side. The medical eye visit, enrolled and billed on its own terms.
A glaucoma check, a diabetic eye exam or an eye infection bills to the patient's medical plan, not the vision plan. We enroll the practice and each optometrist with medical plans and run the medical claims.
Summary
Can an optometrist bill medical insurance?
Yes. A medical eye visit, for an eye disease, injury or symptom, is billed to the patient's medical plan, and the optometrist has to be enrolled with that plan first. A routine vision exam goes to the vision plan, which is a separate enrollment with separate claims.
The vision plan and the medical plan take separate claims.
The same patient can carry both, and the reason for the visit decides which plan gets the claim.
Medicare treats a doctor of optometry as a physician for the services the state license allows, so an optometrist enrolls with Medicare like any other clinician. Medicare does not pay for the routine exam for glasses, or for the refraction, even when both happen during a covered medical visit. The claim has to separate the two.
Each commercial medical plan credentials optometrists on its own terms. Being in a vision network puts the practice in none of them.
Medical enrollment, then medical claims.
- Enrollment
- The practice and each optometrist with Medicare through PECOS, your state's Medicaid and its plans, and the commercial medical plans your patients carry.
- Which plan gets the claim
- A written rule for your front desk: which visits go to the medical plan, which to the vision plan, and what the note must say for each.
- Claims and denials
- Medical claims built and followed until paid, and each denial traced to its cause and worked.
- Reporting
- What the medical side brings in, payer by payer, on the status record.
| Piece of work | Fee |
|---|---|
| The practice, each medical plan | $450 |
| Each optometrist, each medical plan | $350 |
| An optometrist's CAQH profile | $300 |
| Medical billing for the practice | By agreement |
Common questions from optometry practices.
We are in every vision network. Are we enrolled with medical plans?
Not by that alone. A vision network and a medical plan's network are separate enrollments, even when the same insurer runs both. The review lists which medical plans have the practice and each optometrist on file.
Do you bill our vision plans too?
No. We run the medical side. Your vision billing stays as it is.
Tell us which medical plans your patients carry.
We check where the practice and each optometrist stand with them. The review starts from your report totals.
Say which vision plans you take now.