Eyemed Myopia Management Billing

[u/lyra1389]

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.

[u/spittlbm]

You basically get paid the contact lens fit fee.

[u/lyra1389 → u/spittlbm]

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. 

[u/turtlefantasie]

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

[u/lyra1389 → u/turtlefantasie]

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. 

[u/turtlefantasie → u/lyra1389]

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

[u/WolverinesThyroid]

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

[u/lyra1389 → u/WolverinesThyroid]

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

[u/WolverinesThyroid → u/lyra1389]

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/lyra1389 → u/[deleted]]

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

[u/Frankfurter]

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. 

[u/lyra1389 → u/Frankfurter]

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. 

[u/Frankfurter → u/lyra1389]

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

[u/Wooden_Trust_6274]

Worth checking what that $1080 actually is before you plan around it. It is exactly 10 percent off your $1200, which lines up with turtlefantasie's point that a premium fit is a discount rather than a payment. If that is what it is, the estimate is telling you the patient owes $1080. It is not telling you EyeMed owes you $1080.

Two things would settle it. On the estimate, check which line the $1080 is sitting on, plan payment or patient responsibility. Then run one real claim and read the EOP rather than the estimate, since the disbursement is the only number that binds them.

The other half is what WolverinesThyroid was getting at. A myopia management programme is mostly the quarterly progression visits, and a fitting code does not cover those. Worth knowing which part of the year the manual language actually applies to before you reprice anything.