Medicare Reimbursement for Extended Ophthalmoscopy

EO is a detailed examination and drawing of the fundus that goes beyond the standard funduscopy of an eye exam.  Pupil dilation is implicit; binocular indirect ophthalmoscopy (BIO) is preferred; it may include scleral depression.  It is identified in CPT as 92225 (Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; initial) and 92226 (subsequent).

CPT further states, “Routine ophthalmoscopy is part of general and special ophthalmologic services whenever indicated.  It is a non-itemized service and is not reported separately.”

EO is indicated for a wide range of serious posterior segment pathology.

This FAQ addresses the following:

  1. What is extended ophthalmoscopy (EO)?
  2. What is the difference between 92225 and 92226?
  3. What diagnoses support the use of 92225 and 92226?
  4. If BIO of the fundus is normal, may 92225 or 92226 be claimed?
  5. What documentation is required in the medical chart to support this service?
  6. How large do the retinal drawings need to be?
  7. What other attributes make a high quality EO retinal drawing?
  8. What does Medicare allow for 92225 and 92226?
  9. How frequently is this test performed?
  10. What other issues impact EO?

A list of common diagnoses is also included.

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