In this exclusive article, AEG Vision outlines its focused effort to build a standardized myopia management program to streamline the specialty across its expanding network of over 500 eye care practices. This special feature is part of Insight Media’s Myopia Masterclass Series, which recently covered establishing fees for myopia management.
With childhood myopia on the rise, AEG Vision is committed to helping our doctors successfully offer myopia management services. Because doctors most often requested support with coding and billing, we focused on developing and training a standardized coding framework.
Our goal was to give providers the flexibility to freely exercise their clinical judgment while complying with our insurance contracts and delivering a consistent patient experience. Here’s an overview of how we strived to accomplish this goal.
1. Start with the Clinical Pathway
Before discussing fees, we first determined which treatment modalities our providers wanted to offer. Each treatment pathway has its own clinical workflow, visit cadence, chair time, diagnostic testing, and material costs. Because of these differences, each modality has its own fee structure. While the pricing may vary, the process remains standardized.
2. Know Your Payers
Once the clinical pathways were established, we built pricing around the care being provided, not the other way around.
Our team reviewed payer contracts and provider manuals to understand what professional services and/or materials are covered benefits versus patient-responsible expenses. As more insurers begin publishing guidance on myopia management, we continue to update simple payer reference guides that help our practices quickly determine coverage while remaining compliant.
One decision was especially important to us: we chose not to globally package professional services and materials into a single cash fee. This gives us the flexibility to separately bill professional services and materials, as insurance coverage sometimes varies. We believe this approach is both more transparent for families and consistent with our contractual obligations.
3. Train the Entire Team
A successful myopia management program extends far beyond the exam lane. Providers, technicians, front desk staff, managers, and billing teams all play an important role in helping patients understand treatment options, visit cadence, professional fees, material costs, and insurance coverage. Investing in staff education creates confidence, consistency, and a better patient experience.
4. Make Patient Education Easy
Once the internal process was established, we focused on supporting teams in educating patients and their families.
Clear educational materials help improve patient understanding and compliance with recommendations. We created patient agreements tailored to each treatment modality. Fortunately, practices don’t have to create everything themselves. Many outstanding patient education resources are already available through contact lens manufacturers, academy organizations, and myopia management advocacy groups.
AEG’s Takeaway: Standardize the Process, Not Necessarily the Price
While every treatment modality carries different clinical demands, every patient still deserves a consistent experience. By defining your treatment pathways, understanding payer expectations, training your team, and equipping patients with clear information, your practice can build a sustainable myopia management program that is clinically sound, financially transparent, and compliant with carrier contracts.
Pro Tip: Myopia management coverage is evolving quickly. Make it a habit to review payer provider manuals and subscribe to payer email updates. While many policies are updated annually, we’ve already seen a few payers release mid-year guidance. Staying informed today can prevent billing headaches tomorrow.
Sarah Haney, COPC, CPMA, CHC, is Sr. Manager, Coding, Compliance & Education at AEG Vision. Jamy Borbridge, OD, is Senior Director of Professional Development at AEG Vision.