Optometrist performing slit lamp eye examination — Medicare medically necessary eye care documentation CPT 92012 92014

Medicare Billing Compliance Intelligence · Independent OD Practices

Your next Medicare audit won't give you a warning.

Monthly compliance intelligence for independent optometry practices — CPT codes, OIG enforcement priorities, glaucoma screening rules, diabetic eye exams, and the routine vs. medical necessity documentation line that trips up most ODs.

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17,000+ Independent OD practices billing Medicare

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The Compliance Gap

Medicare doesn't cover routine eye exams.
The line between routine and medical is where ODs get audited.

Medicare Part B covers medically necessary eye care — comprehensive exams when there's a clinical reason, not simply because a patient wants updated glasses. On paper, the distinction is clear. In practice, most independent ODs are billing without the chart documentation that makes that distinction defensible under a post-payment review.

"The OIG has documented optometry billing as an active audit priority. Improper payments are being flagged at the CPT 92002–92014 level across MAC jurisdictions."

Add glaucoma screening codes (G0117, G0118) — which require documented high-risk patient criteria that most practices don't capture systematically — and diabetic eye exam rules that vary by whether the payer is Medicare or Medicaid, and you're managing three overlapping compliance frameworks with one billing staff member and zero dedicated compliance support.

That's the gap. We close it with plain-English intelligence every month — before the audit request lands in your inbox.

Top Audit Triggers — Independent Optometry

OIG Work Plan + MAC enforcement data

92012 / 92014

Established patient exams billed without documented medical diagnosis — most common optometry denial and recoupment trigger

High recoupment risk

G0117 / G0118

Glaucoma screening billed without documenting that patient meets CMS high-risk criteria (diabetes, family hx, specific demographics)

Active MAC focus area

S0621

Diabetic eye exam billed to Medicare when Medicaid is the correct payer — or vice versa — based on state program rules

Cross-payer billing error

Vision Split

Full visit billed to Medicare when a portion was routine vision — incorrect unbundling with recoupment exposure

Documentation gap

What's Covered Every Month

Intelligence across every billing area
that puts independent OD practices at risk.

Eye doctor reviewing patient medical chart — Medicare Part B medically necessary eye exam CPT 92002 92004 92012 92014 documentation requirements

Medicare Part B Eye Exams

CPT 92002, 92004, 92012, 92014 — Documentation that survives a post-payment review

Every monthly report covers the medical necessity documentation standards for your highest-volume codes — what the chart needs to say, what triggers denials, and how your MAC is interpreting coverage this cycle.

92002 92004 92012 92014

Optometrist performing glaucoma screening examination with tonometer — G0117 G0118 Medicare high-risk patient eligibility criteria

Glaucoma Screening Codes

G0117 & G0118 — High-risk eligibility, frequency limits, and what the chart must say

Medicare only covers glaucoma screening for documented high-risk patients. We monitor eligibility criteria, frequency restrictions, and MAC-specific coverage interpretations so you're not billing these codes without the documentation to support them.

G0117 G0118 High-Risk Criteria

Healthcare provider reviewing diabetic patient eye exam records and insurance billing — S0621 Medicare Medicaid optometry billing compliance documentation

Diabetic Eye Exams + Vision Split Billing

S0621, payer rules, and the routine-vs-medical split that catches practices off guard

Diabetic eye exam coverage varies by state Medicaid program vs. Medicare — and billing the wrong payer is a recoverable error. We also cover vision/medical split billing: when a single visit has both components, how to document them, and how to bifurcate the claim correctly.

S0621 ABN Guidance Split Billing

How It Works

Set up once. Intelligence every month.

Subscribe & Complete Your Practice Profile

Tell us your state, your payer mix, and the codes your practice bills most frequently. Takes under three minutes after checkout.

We Analyze Current CMS & OIG Priorities

Our system processes current MAC bulletins, OIG enforcement priorities, and payer policy changes — filtered for your specific practice profile.

Report Delivered to Your Inbox

Plain English. No 40-page PDFs. No legal jargon. Formatted for a practice owner who has 10 minutes, not a compliance team with 10 hours.

Stay Current, Every Month, Automatically

Coverage rules change. MACs update policies. OIG shifts priorities. Your intelligence updates with them — nothing to manage, nothing to renew.

Pricing

One plan. Everything included.

Independent optometry practices spend thousands per year on compliance consultants and billing audits — after a problem has already surfaced. OptometristBillingClarity is built for the front end: staying current before the audit request arrives.

At $247 per month, a single avoided recoupment — on even one month of 92014 claims — covers the full year's subscription.

No compliance staff required
No contracts — cancel anytime
First report within 24 hours of subscribing
Monthly reports delivered on the 1st
Tailored to your state, payer mix, and billing profile

Monthly Compliance Intelligence

$ 247 /month

Monthly Medicare billing compliance intelligence report
CPT 92002, 92004, 92012, 92014 — routine vs. medical necessity guidance
Glaucoma screening G0117/G0118 — eligibility criteria & frequency limits
Diabetic eye exam S0621 — Medicare vs. Medicaid payer rules
Vision vs. medical split billing — documentation & claim structure
OIG enforcement priorities for optometry, updated monthly
Carrier-specific policy updates for your payer mix
One plain-English action item per report

Subscribe Now — $247/month →

No contracts · Cancel anytime · First report within 24 hours

What ODs Are Saying

Built for solo and small optometry practices
with no dedicated compliance staff.

I've been billing 92014 for established patients for years without thinking about medical necessity documentation. This flagged exactly what was missing in my charts. Genuinely eye-opening.

Dr. M. Callahan, OD

Solo optometry practice · Ohio

The glaucoma screening section has been worth it on its own. I didn't realize I was billing G0117 for patients who didn't meet high-risk criteria. That's real recoupment exposure I didn't know I had.

Dr. S. Okonkwo, OD

Two-location group practice · Texas

My biller and I review the report together every month. It's become our compliance huddle — plain enough for me to follow, specific enough that we actually act on it.

Dr. L. Ferreira, OD

Independent practice · Florida

Frequently Asked Questions

Common questions from OD practice owners.

Is this legal advice or billing advice?

Neither. This is compliance intelligence — general educational information about CMS guidelines, OIG enforcement priorities, and carrier policies. It helps you stay informed and ask better questions, but does not replace a healthcare attorney or certified professional coder.

How is the report tailored to my practice?

When you subscribe, you complete a brief intake form with your state, payer mix, and most-billed codes. Every monthly report is generated specifically for your profile — not a generic newsletter sent to all subscribers.

How quickly do I receive my first report?

Your first intelligence report is delivered within 24 hours of subscribing and completing the intake form. Monthly reports go out on the 1st of each month thereafter.

Can I cancel at any time?

Yes, at any time. No contracts, no cancellation fees. You retain access through the end of your current billing period.

I have two locations — does one subscription cover both?

Yes, if your locations share the same payer mix and are in the same state. For practices with significantly different payer mixes or multi-state setups, contact us to discuss the right configuration.

What if I have questions after reading my report?

Reply directly to any report email and we'll address your question in the next cycle. For urgent compliance matters, we recommend consulting a healthcare attorney or a CPC with optometry billing experience.