Optometry Invoice Template

Free invoice templates for optometrists built for eye exam fees, frames and lenses, and contact lens fittings. Download and edit in PDF, Word, Excel, Google Docs, or Google Sheets.

Also called: optometry invoice, optometry bill, or optometrist invoice.

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Download Free Optometry Invoice Templates

Download a template, then edit in PDF, Word, Excel, Google Docs or Google Sheets. Print or email when ready.

Sheets, Excel, Word and Doc Templates Coming November 21, 2025.

Custom Optometry Invoice Template

Best for:

Logo, lab and vision plan fields.

Editable Optometry Invoice Template

Best for:

Edit items, coatings, discounts.

Printable Optometry Invoice Template

Best for:

Copay, insurance ref, signatures.

Free Optometry Invoice Template

Best for:

Exam, Rx, PD, frames, lenses, notes.

How to Invoice as an Optometrist

A simple flow that covers services, products, and insurance so everyone knows what they owe.

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In 5 Steps:

Right after the visit, note what you did and what was ordered.
Check insurance benefits and mark copays, deductibles, and not-covered items for the patient.
For custom eyewear or large contact orders, take a deposit and note the refund terms.
Build the invoice separating services from products, add required codes or order refs, and send it.
When the order is dispensed, apply the deposit, post insurance payments, and collect the balance.

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What to Include in an Optometrist Invoice

These are the must-have fields for clear, compliant invoices.

Practice name, address, phone, and email
Provider name, credentials, and NPI
License number and tax ID
Patient name and contact info
Invoice number and invoice date
Service location
Insurance payer name and member ID
Authorization or claim reference number
Payment terms and due date
Product order or Rx number
Sales tax on products only, check local rules
Warranty or return policy summary

Billing Scenarios for Optometrists

How to label charges so every invoice makes sense the moment your clients see it.

Eye Exam (Routine); Refraction

Routine eye exam where the refraction isn’t covered

This separates the visit from the prescription test so insurance and patient responsibility are clear.

Contact Lens Fitting; Insertion & Removal Training

First-time contact lenses needing extra chair time

It shows the clinical fitting apart from the teach session.

Medical Evaluation; Retinal Imaging/OCT

Red, painful, or infected eye that needs imaging

It links the medical visit to the diagnostic test without mixing fees.

Frames; Lenses + Coatings

New glasses with a specific frame and custom lenses

Include provider name, credentials, license, NPI, and tax ID on every invoice and align them with the chart.

Contact Lens Supply (Annual); Shipping

Annual contact lens supply shipped to the patient

It shows the product cost and the delivery cost as two items.

After-Hours Surcharge; Office Visit

It flags the premium for off-hour care next to the exam fee.

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Standard patient fees and services for optometry

Itemize eye exams, frames and lenses, contact fittings, coatings, and allowances with professional invoice line items.

Charge or Service

Unit

Taxable

When to use

How to show it

Comprehensive eye exam

Time

Routine vision and eye health visit

Time × hourly rate. Document findings and Rx; include dilation only when indicated.

Contact lens fitting

Time

New wearer or Rx change

Time × hourly rate. Include keratometry, topography, and trial evaluation to justify fit.

Contact lens teach & insertion

Time

First-time wearer training

Time × hourly rate. Coach hygiene and insertion/removal; reduce callbacks.

Emergency red-eye visit

Time

Acute irritation, injury, or infection

Time × hourly rate. Triage, treat, and document urgency and follow-up.

OCT retinal imaging

Item

Macula/nerve evaluation

Qty × unit rate. Capture baseline images; attach to chart for monitoring.

Visual field test

Item

Suspected glaucoma or defects

Qty × unit rate. Run threshold test; save printout and summary to record.

Eyeglass frames

Item

Taxable

Patient selects a frame

Cost × (1 + markup%). Record model, color, and size for warranty tracking.

Single-vision RX lenses

Item

Taxable

Distance or near-only prescription

Cost × (1 + markup%). Include material, index, PD/OC, and lab job number.

Anti-reflective coating

Item

Taxable

Glare reduction upgrade

Qty × unit rate. Note brand and care instructions; improves clarity and durability.

Contact lenses (box)

Item

Taxable

Supply of disposable lenses

Qty × unit rate. Verify current prescription; note replacement schedule.

Save and reuse your optometry services and prices

Create a free account and save exam fees, frame and lens prices, and fitting fees once, so nothing gets retyped.

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Common Optometrist Invoicing Mistakes

Real-world billing gets messy fast, but small fixes prevent disputes and delays. Use these to keep cash flow steady and patients happy.

Mistake

How to fix it

Combining services and products on one line confuses coverage and creates tax errors.

List professional services apart from products and accessories. Show tax only on taxable items and keep totals separate.

Not documenting deposits and terms leads to cancellations and refund fights.

Record the deposit amount, date, and policy on the invoice, then apply it at dispense and show the remaining balance.

Mark patient-responsible items with a brief reason and show what is due today versus after insurance processes.

Include provider name, credentials, license, NPI, and tax ID on every invoice and align them with the chart.

Omitting authorization or claim references leads to denials and rework.

Capture prior auth numbers and claim references on the invoice and mirror them in your system notes.

Not stating warranty or remake windows turns small fixes into free reworks.

Add the warranty period and remake or return cutoff in plain language, and give a short process for how to use it.

Optometry Invoice FAQs

Bill eye exams, contact lens fittings, eyewear, coatings, imaging, and urgent visits with clean line items, add-ons, and terms. Faster payment, fewer write-offs, clear answers.

How should I bill a comprehensive eye exam versus a contact lens fitting?

List each service as its own line. Example: “Comprehensive Eye Exam (CPT 92004): $135” and “Contact Lens Fitting: $80,” with “Follow-up Fit Check: $25.”

What line items belong on eyewear orders?

Break out frames, lenses, and every add-on. Example: “Frame: $165,” “Single Vision Polycarbonate: $120,” “Anti-Reflective Coating: $65,” “Blue-light Filter: $35,” “PD Measurement: $10.”

How do I show vision plan copays, deductibles, and non-covered balances?

Display plan adjustments under the service. Example: “Exam: $135, Vision Plan Allowance: ($85), Patient Copay: $20, Non-covered Retinal Photo: $39, Amount Due: $109.”

Should I charge a separate refraction fee?

Yes if your payer treats refraction as non-covered. Example: “Refraction (CPT 92015): $45.” Add “Not covered by plan. Patient responsibility.”

How should I price urgent after-hours visits?

Use a visit code plus an after-hours fee. Example: “Urgent Red Eye Visit: $95” and “After-Hours Surcharge: $60.” If you are the on-call eye doctor, note the time seen.

What’s the right way to show a glasses remake or warranty replacement?

Show the remake as $0 with the warranty used, or list the lab fee if not covered. Example: “Lens Remake under 60-day Warranty: $0,” or “Remake Processing: $25.”

How do I handle no-shows and late cancellations?

State the policy and list the fee as its own line. Example: “Missed Appointment Fee: $35.” Rules vary—check local rules.

What should an optometry invoice include for HSA/FSA reimbursement?

Include provider details, NPI, patient name, service codes, and itemized amounts. Example: “Optometrist NPI 1234567890, Exam 92014: $110, Contact Lens Supply: $180.” You can speed this up with our Optometry Invoice Template.