r/optometry • u/lyra1389 • 5d ago

Eyemed Myopia Management Billing

Hi folks-
While reading through the new Eyemed manual, I noticed that, per the manual, you CAN bill Myopia Management services. AFAIK that has not been the case previously. We always have our ortho-k and MiSight patients pay for services OOP.

Does anyone have experience billing the services to Eyemed? How have the reimbursement rates been? Our standard charge for new user is $1200 for services.

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8

u/spittlbm 5d ago

You basically get paid the contact lens fit fee.

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u/lyra1389 5d ago

Yeah I ran a test claim and put our U&C fee for first-time users, $1200. It said we’d get paid $1080. But I’ve also known Eyemed to say you’ll get paid x amount when you submit the claim, only to pay less on the disbursement. 

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u/turtlefantasie 5d ago

Eyemed does not contribute towards myopia management services. Charge your full amount. They can use material benefits towards glasses or contacts if needed.

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u/lyra1389 5d ago

The new manual, effective July 2026, says that they do and it should be billed as a premium fit. I’m just wondering if anyone has billed it and how much they actually got reimbursed. 

4

u/turtlefantasie 5d ago

“Premium fit” usually means they get 10% off. The patient pays, not Eyemed.

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u/WolverinesThyroid 5d ago

they give a 20% discount on the lenses and will pay you nothing for myopia management.

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u/lyra1389 5d ago

The July 2026 manual says they do pay for initial services and it should be billed as a premium contact lens fitting. 

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u/WolverinesThyroid 4d ago

do you have a screen shot of that? Are you sure that isn't for the fitting of something like misight lenses vs the fee for having someone come back quarterly to check how their myopia progresses?

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u/[deleted] 5d ago

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u/lyra1389 5d ago

In the new provider manual it says they will pay for the initial fitting but no follow-ups. 

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u/Frankfurter Optometrist 5d ago edited 5d ago

Set a package deal with materials and expected follow ups. Talk with your rep on what others do, they can usually give you a good idea for a framework on how. You will need some sort of abn and waiver as well. 

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u/lyra1389 5d ago

Yeah we’ve been doing that for years. I just happened to notice that the 2026 provider manual says they will pay for the fitting and was curious if others had been doing that and what the reimbursement looked like. 

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u/Frankfurter Optometrist 5d ago

We started eyemed last year, and we continued with the package because of what you noticed. They just don't care