Billing & Coding Dry Eye Like a Pro (Without Getting Burned)

By Christopher Wolfe

If you’re serious about treating dry eye, you have to be just as serious about how you bill and code for it. Otherwise, you’ll end up doing what too many ODs do without realizing it, leaving money on the table, confusing your staff, or frustrating your patients.

Peeq Pro provides a unique set of workflows that ensure your patients great treatment and are compliant - but your office has to bill and code to ensure you get paid for your services.

Dry eye isn’t “just dryness.” It’s a chronic, progressive condition that deserves medically appropriate management and medically appropriate billing. But if you want to bill confidently (and compliantly), you need a system that supports both your clinical decision-making and your documentation.

Let’s break down how to do this—step by step—so you can get paid for the value you’re providing.

Step 1: Separate Identification from Management

One of the most common mistakes I see? Doctors discover signs of dry eye during a comprehensive exam and immediately dive into full-blown treatment mode—and try to bill it medically on the same day.

That’s a fast track to denials, audit flags, and headaches.

Instead, use your comprehensive exam to identify and document, not to manage. During that visit:

• Record your findings (staining, telangiectasia, meibomian gland dropout, etc.)
  

• Start conservative therapy (warm compresses, lid hygiene, artificial tears) - Dry Eye Essential Box from Peeq Pro is a good starting point
  

• Document patient education and whether they began therapy - Peeq Pro’s workflow organizes a much higher compliance rate than our office alone

That documentation does two key things:

1. Justifies future medical management (like Rx drops or in-office treatments)
   

2. Sets you up for a dedicated follow-up—the ocular surface disease evaluation (OSDE)
   

That OSDE visit is where your real diagnostic and billing muscle comes in.

Step 2: The OSDE Visit — Where the Work (and Reimbursement) Happens

At the OSDE, you’re doing more than observation—you’re managing a chronic condition.

Here’s how the coding usually breaks down:

• 99214 — when managing dry eye with Rx therapy or performing a procedure involving documented risk
  

• 99213 — when recommending OTC options with low complexity
  

• G2211 — don’t forget this one! If you’re the primary clinician managing the patient’s ongoing dry eye care, this code adds reimbursement for the extra coordination, time, and decision-making complex management requires
  

Diagnostic testing often includes:

• Meibography (92285)
  
  
• Tear Osmolarity (83861, per eye)
  
  
• Tear MMP-9 (83516, per eye)
  

These tests aren’t mandatory for diagnosis—but they strengthen documentation and support your medical necessity in case of audit.

Step 3: Understanding Medicare Reimbursement

Many people ask me about appropriate billing amounts. This is a super tricky thing as we don’t want to fix prices or inform others about our billing amounts. That’s illegal.

But one simple thing to get right is medicare reimbursement. If you’re treating Medicare patients (and you probably are), here’s how the reimbursement typically shakes out:

(Rates vary slightly by region, but these are ballpark 2025 Medicare national averages.)

When you combine these appropriately and document your rationale, you can legitimately bill for the true complexity of dry eye care. That’s not “gaming the system.” That’s getting paid for the chronic disease management you’re actually doing.

Step 4: Handling Cash-Pay Patients (Without Crossing Compliance Lines)

Here’s where some practices get tripped up. You can’t just “bundle” dry eye services into a made-up package fee and call it a day. Even for cash-pay patients, best practices (and compliance standards) still apply:

• Use standard CPT/HCPCS codes
  

• Provide a Good Faith Estimate (GFE) before service
  

• Charge consistently across all payers
  

If you’re in-network, bill insurance.

If you’re out-of-network, charge the same fees using the same codes and provide the patient a clear, itemized invoice.

Transparency isn’t just good ethics—it’s protection for your practice.

Step 5: Staff Training and Front-Desk Clarity

Most dry eye billing issues don’t start in the exam lane—they start at the front desk.

Make sure your team knows how to:

• Explain why a patient is coming back for an OSDE
  

• Differentiate covered vs. non-covered services
  

• Present cost expectations clearly
  
  

Here’s a script that works well:

“Dr. Wolfe identified signs of ocular surface disease today and would like to bring you back for a dedicated evaluation. If your insurance covers the visit, we’ll bill them. If not, we’ll provide an estimate before your appointment so you can decide how you’d like to proceed.”

It’s not about selling; it’s about informed consent and clarity. Many patients suffering from dry eye are desperately seeking help. They will pay to relieve their on-going discomfort. Its okay to be paid to provide this diagnosis, treatment, and relief.

Step 6: Documentation Is Everything

If it’s not documented, it didn’t happen. That means every visit should note:

• Step one therapy initiation
  

• Symptom history and risk factors
  

• Medical rationale for any procedures or prescriptions
  
  

Keep it specific, relevant, and timed correctly. The number one cause of denied claims isn’t wrong coding—it’s weak documentation.

The Bottom Line

If you want to treat dry eye like the chronic disease it is and get reimbursed fairly, you need to:

✅ Separate diagnosis from management
✅ Use proper codes (99213/99214, 92285, 83861, 83516, G2211)
✅ Bill transparently, even for cash-pay patients
✅ Train your staff on communication
✅ Document everything

Dry eye care is incredibly rewarding. But it’s also a business, and it only works if your billing supports your clinical effort. Peeq Pro provides many frameworks that help overlay your own process - but ultimately, it is up to you and your team to bill for the services rendered.

So, if you’re ready to “bill like a pro,” start with your documentation. That’s where every successful claim—and every healthy patient—begins.