The New Optometry Practice Billing Guide: Rates, Invoices, and Payments
Learn how to set billing rates, create invoices, and handle payments for a new optometry practice. Practical steps and realistic 2026 figures.
Starting an optometry practice means you need a billing system that works from day one. This guide covers the three core pieces: setting rates, creating invoices, and managing payments. You will get concrete numbers and steps you can apply this week.
Setting Your Rates
Your rates depend on your location, overhead, and target patient base. In 2026, typical fees for common services in the U.S. are:
| Service | Average Fee Range |
|---|---|
| Comprehensive eye exam | $150-$250 |
| Contact lens fitting | $100-$200 |
| Optical coherence tomography (OCT) | $50-$100 |
| Visual field test | $50-$100 |
These are cash or out-of-network prices. If you accept insurance, you must contract with vision plans like VSP, EyeMed, or Davis Vision. Contracted rates are lower, often 30%-50% less than cash prices. For example, a comprehensive exam might reimburse $80-$120.
To set your cash rates, research three local competitors. Call or check their websites. Then price yourself within 10% of the average. If you are in a high-cost city like New York or San Francisco, add 15%-20%.
Also decide on product markups. Standard practice is to mark up frames 2.0 to 2.5 times cost, and lenses 3 to 4 times cost. For example, a frame that costs you $100 should retail for $200-$250. Lenses that cost $50 should retail for $150-$200.
Creating Invoices
Your invoice must be clear and professional. Use practice management software like RevolutionEHR, Eyefinity, or SimplePractice. These tools generate invoices automatically and track payments. Monthly costs range from $100-$300 per provider, depending on features.
An invoice should include:
- Your practice name, address, phone, and NPI number
- Patient name and date of service
- Itemized charges (exam, tests, products)
- Insurance adjustments and patient responsibility
- Payment due date
- Accepted payment methods
Send invoices immediately after the visit. For insurance claims, submit electronically within 24 hours. Most practices file claims within 2 business days. For patient balances, email or mail an invoice within 3 days.
Use a numbering system for invoices: for example, 2026-0001. This helps with tracking and tax preparation.
Handling Payments
You need a reliable payment system. Options include:
- Credit card terminals: Costs $50-$100 per month for processing fees (around 2.5%-3.5% per transaction).
- Online payment portals: Many practice management systems include this. Fees are similar to credit cards.
- Patient financing: Offer third-party financing like CareCredit. This costs nothing upfront, but you pay a discount fee of 4%-6% on each financed amount.
Collect payment at the time of service for copays, deductibles, and non-covered services. For larger balances, set up a payment plan. For example, allow 3 monthly installments for amounts over $500.
Track accounts receivable (AR) weekly. Aim for AR over 90 days to be less than 10% of total receivables. If it is higher, follow up with statements and phone calls.
Insurance Billing Basics
If you accept insurance, you must verify eligibility before each visit. This confirms coverage and copay amounts. Use your software’s eligibility check or call the payer. Do this 24 hours before the appointment.
Submit claims with accurate coding. Use ICD-10 codes for diagnoses and CPT codes for procedures. For example, a routine exam is CPT 92004 (comprehensive, new patient) or 92014 (established). Common diagnosis codes include H52.0 (hypermetropia) and H52.1 (myopia).
Expect claim processing times of 14-30 days. If a claim is denied, appeal within 30 days. Common reasons for denial: missing authorization, incorrect coding, or lack of medical necessity. Keep a log of denials to spot patterns.
Payment Policies and Communication
Create a written payment policy and give it to every patient at the first visit. Include:
- Payment due at time of service
- Accepted methods (cash, credit card, check)
- Interest or fees for late payments (check your state laws)
- Returned check fee (typically $25-$50)
Post the policy in your waiting room and on your website. Train your front desk staff to discuss costs before treatment. For example, say, “Your exam is $180, and your copay is $30. How would you like to pay?”
Practical Steps for This Week
- Research local rates: Call 3 competitors and note their prices for exams and contact lens fittings.
- Set your fee schedule: Write down your cash rates for all services and products.
- Choose billing software: Compare RevolutionEHR, Eyefinity, and SimplePractice. Start a free trial of one.
- Draft a payment policy: Use the points above and print it.
- Verify insurance contracts: If you plan to accept insurance, contact VSP or EyeMed to start credentialing. This can take 60-90 days, so begin now.
FAQ
Q: How much should I charge for an eye exam? A: In 2026, cash rates range from $150 to $250. Set yours based on local market research. Insurance contracted rates are lower, often $80-$120.
Q: What is the best way to collect payments from patients? A: Collect at the time of service. Use a credit card terminal or online portal. Offer payment plans for balances over $500.
Q: How long does it take to get paid by insurance? A: Most claims are paid in 14-30 days. Submit claims electronically and track denials to speed up the process.
Q: Do I need billing software? A: Yes. It automates invoicing, claims, and payment tracking. Costs range from $100-$300 per month. It saves hours of manual work.
The Bottom Line
Billing is a core part of running an optometry practice. Set rates based on local data, use software to create invoices, and collect payments promptly. Start with the five steps this week. They will set a solid foundation for your practice’s financial health.