In Washington, glaucoma isn’t just a growing public health concern—it’s also a billing compliance minefield. Ophthalmologists and optometrists who provide screenings must walk a fine line between quality patient care and precise documentation, or risk denials, audits, and even allegations of fraud. While glaucoma is one of the leading causes of irreversible blindness in the U.S., improperly billed screenings can lead to costly mistakes that undermine your practice’s revenue cycle.

At Instapay Healthcare Services, Washington’s ophthalmology billing specialist, we help practices ensure their optometry billing in Washington stays compliant, especially when it comes to preventive services like glaucoma screenings.

Who Qualifies for Glaucoma Screening Coverage?

Medicare Part B covers annual glaucoma screenings for high-risk patients, but only if certain criteria are met. High-risk groups include:

• Individuals with diabetes
• Individuals with a family history of glaucoma
• African Americans aged 50+
• Hispanic Americans aged 65+

Many practices assume a diagnosis code related to “suspected glaucoma” is enough. It’s not. To receive reimbursement, providers must use the correct combination of diagnosis and procedure codes and prove the patient meets eligibility criteria.

Common Coding and Documentation Pitfalls

One of the biggest challenges in optometry billing compliance for Washington practices is misunderstanding what counts as a “screening” versus a diagnostic exam. For a Medicare-covered screening:

• Use HCPCS code G0117 (for optometrists) or G0118 (for ophthalmologists)
• Ensure documentation clearly supports risk category
• Avoid billing a full eye exam (e.g., 92014) on the same day unless it’s medically necessary and modifier -25 is applied

Washington insurers may follow different rules for commercial plans, so it’s crucial to verify each payer’s policies before submitting claims.

Local Compliance Considerations in Washington

Washington State’s Medicaid program, Apple Health, provides glaucoma screenings under different criteria, often requiring prior authorization or referral documentation from a primary care provider. Some plans may cover diagnostic testing like optic nerve imaging (92133) or visual field testing (92083) under different guidelines than Medicare.

Practices that serve mixed patient populations must ensure front-desk and billing teams are trained to distinguish between vision benefits and medical necessity—especially when scheduling routine exams that may turn into screenings.

Why Auditors Are Watching

Glaucoma screening claims are frequently audited due to the high volume of denials and documentation errors. In Washington, where preventive care is emphasized through public health outreach, billing compliance must match clinical intent. Claims flagged for:

• Missing risk documentation
• Unsupported use of modifier -25
• Duplicate screening within a 12-month window

can lead to take-backs, delays, or even a review of your full ophthalmology billing history.

Partnering with a Billing Specialist That Understands Washington

Instapay Healthcare Services isn’t just any billing company—we’re Washington’s optometry billing specialist with deep knowledge of local payer behavior and federal guidelines. We help ophthalmology practices:

• Identify and prevent coding errors
• Streamline documentation for Medicare and commercial payers
• Stay compliant with Washington Medicaid policies
• Optimize preventive care billing without increasing audit risk

Final Thoughts

Glaucoma screenings are essential—but only if done right. With rising scrutiny on preventive services, ophthalmologists and optometrists in Washington must stay ahead of evolving billing rules. With Instapay Healthcare Services as your billing partner, you can focus on patient care while we ensure your practice stays compliant, profitable, and audit-ready.