Ophthalmology EHR and AI Medical Billing Software

Ophthalmology mixes medical eye care, routine vision and surgery, each billed differently. XEHR keeps the exam, the testing and the claim aligned.

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Chart · Office visit

Lastname, Firstname M. Sample patient · DOB 01/01/1980 · Commercial

Eligible

BP128/82

HR72

BMI26.4

Temp98.6

Progress noteAI Scribe draft

Blurred vision and glare at night.

H25.11 Nuclear cataract, right eye

ReviewSign note

Diagnosis carried to the claimH25.11

THE HARD PARTS

What makes ophthalmology billing hard

Medical or routine vision

The same exam can be billed to medical insurance or a vision plan depending on the reason for the visit.

Testing per eye

Diagnostic imaging is often billed per eye or both eyes, with frequency limits.

Drugs injected in the office

Injection drugs are expensive, and the dose and eye must be documented exactly.

WHERE THE WORK HAPPENS

How ophthalmology care is delivered and billed

Ophthalmology is a high-volume office specialty with a large share of diagnostic testing and in-office procedures, plus surgery in surgery centers. Medical eye visits are billed to health insurance on the professional claim, while routine vision exams are often covered by separate vision plans. Testing such as imaging of the retina and visual fields is billed per eye or per test, and injections into the eye add costly drugs to the claim.

What payers check on ophthalmology claims

Eye diagnosis codes carry laterality and, for glaucoma and retinopathy, stage or severity.
A routine vision exam for glasses is not covered by most medical plans; the reason for the visit decides which plan is billed.
Diagnostic tests such as retinal imaging have frequency limits and require a documented interpretation.
Drugs injected into the eye are billed in their defined units and often require prior authorization or step therapy.
Cataract surgery carries a 90-day global period, and co-management with another provider must be documented and split.

Common ophthalmology diagnoses ICD-10-CM

H25.11	Age-related nuclear cataract, right eye
H40.1131	Primary open-angle glaucoma, bilateral, mild stage
H35.3211	Exudative age-related macular degeneration, right eye, with active choroidal neovascularization
E11.3291	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
H04.123	Dry eye syndrome of bilateral lacrimal glands
H52.4	Presbyopia

Examples only. The provider chooses the code that matches the documented diagnosis, and XEHR checks it against the note and the payer's rules before the claim goes out.

A VISIT ON XEHR

An ophthalmology visit, start to payment

1
Check which plan pays

Vision and medical coverage are both checked, so the visit is billed to the plan that covers the reason for it.
2
Test and examine

Testing is documented per eye with the interpretation, and the exam findings are recorded with laterality.
3
Treat in the office

Injections record the eye, drug and dose; drugs needing approval are flagged before the visit.
4
Bill each eye correctly

Claims carry the right eye, tests and drug units, and cataract surgery starts its global period.

How XEHR helps

From the ophthalmology visit to the payment

Visit reason drives the payerThe documented reason for the visit decides which plan is billed.
Eye-specific documentationRight, left or both is recorded in the note and carried to the claim.
Injection details for billingDrug and dose are documented for an accurate claim.
AI that waits for youThe AI drafts notes and prepares claims; your providers sign and your billers approve.

Claim · CMS-1500

Sample claimLastname, Firstname M. · DOS 03/04/2026

Scrub passed

Scrubbed
Submitted
Accepted
Paid

Service	Dx	Units	Charge
Office visit	E11.9	1	145.00
A1c test	E11.9	1	28.00
Total			173.00

ERA postedPayment applied, no re-keying

Agentic AI for ophthalmology

AI medical billing for ophthalmology practices

XEHR is an agentic EHR: AI agents do the administrative work around every ophthalmology visit, and your team approves what matters. How agentic AI works

Before the claim leaves

The claim-check agent looks for

Eye diagnosis codes carry laterality and, for glaucoma and retinopathy, stage or severity.
A routine vision exam for glasses is not covered by most medical plans; the reason for the visit decides which plan is billed.
Diagnostic tests such as retinal imaging have frequency limits and require a documented interpretation.
Drugs injected into the eye are billed in their defined units and often require prior authorization or step therapy.

Around the visit

Agents run on their own

Coverage checked before each ophthalmology visit
The visit note drafted for the provider to sign
Insurance payments matched and posted
Open claims tracked, denials read and appeals drafted

People decide

Your team stays in charge

Providers sign every note
Billers approve every claim and appeal
Staff submit prior authorizations
Any check can be overridden, with a reason

BUYER'S GUIDE

Questions to ask before you choose an ophthalmology EHR

Ask every vendor, including us. The answers show whether a system was built for ophthalmology work or only adapted to it.

Ask us on a demo

Does the system check both vision and medical coverage before the visit?
Are eye diagnoses captured with laterality and stage?
Are diagnostic tests tracked against frequency limits?
Are injected drugs billed in units with approvals tracked?
Can cataract co-management be documented and split?

QUESTIONS

Ophthalmology practices ask us

Can XEHR bill both medical and vision plans?

Yes. The visit reason decides which plan is billed, and both can be on file for a patient.

Does XEHR handle intravitreal injection billing?

Yes. Drug, dose and eye documented in the note carry onto the claim.

Does XEHR handle both vision and medical billing?

Yes. Coverage for both is checked and each visit is billed to the plan that covers its reason.

Can XEHR bill eye injections?

Yes. The eye, drug and units are recorded and carried to the claim, with approvals tracked.

Does XEHR support optometrists in an ophthalmology practice?

Yes. Each provider documents and bills under their own credentials.

Can XEHR handle routine vision and glasses visits?

Yes. Routine vision visits are billed to the vision plan or collected as self-pay.

How much does XEHR cost for an ophthalmology practice?

Pricing is published: $189 per provider per month for the Clinical plan, $449 per provider per month for the Practice Suite with billing, or 2.5% of collections for RCM as a Service. Month-to-month, with a BAA on every plan. See pricing.

How long does it take an ophthalmology practice to go live?

Small practices are usually live in 2 to 4 weeks, including setup, data migration and training. We agree the plan with you before you sign.

Related specialties

See all specialties

See XEHR set up for ophthalmology

A 30-minute walkthrough on a live test environment, with your specialty's templates and billing.

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