Ophthalmology: You Saw the Patient. You Performed the Procedure. Why Is the E/M Being Denied?

Section analysis by Elizaveta Bannova, Billing Department, WCH

Editorial note: This article draws on CPT and CMS Medicare Claims Processing Manual guidance on Modifier 25, HHS Office of Inspector General audit findings, American Academy of Ophthalmology (AAO) advocacy reporting, and the CY 2027 Medicare Physician Fee Schedule proposed rule, current through August 2026. It is for informational and educational purposes only and does not constitute legal, coding, or compliance advice. Payer-specific requirements should be verified against the current CPT manual and payer policy before billing.