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Medicare Reimbursement for Extended Ophthalmoscopy

EO is a detailed examination and drawing of the fundus, beyond the standard fundoscopy of an eye exam. Pupil dilation is implicit.

As of January 1, 2020, EO is identified in CPT as:

92201 Ophthalmoscopy, extended, with retinal drawing and scleral depression of peripheral retinal disease (e.g., for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral

92202 Ophthalmoscopy, extended, with drawing of optic nerve or macula (e.g., for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral

This FAQ addresses the following:

  1. What is extended ophthalmoscopy (EO)?
  2. What is the difference between codes 92201 and 92202?
  3. What diagnoses support the use of 92201 and 92202?
  4. What documentation is required in the medical chart to support EO?
  5. If binocular indirect ophthalmoscopy of the fundus is normal may 92201 or 92202 be claimed?
  6. How large do the retinal drawings need to be?
  7. What does Medicare allow for 92201 and 92202?
  8. How frequently is EO performed?
  9. What other issues impact reimbursement for EO?

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