Reimbursement for Fundus Photography

Medicare covers fundus photography if the patient presents with a complaint that leads you to perform this test or as an adjunct to management and treatment of a known disease.  If the images are taken as baseline documentation of a healthy eye or as preventative medicine to screen for potential disease, then it is not covered (even if disease is identified).  Also, this test is not covered if performed for an indication that is not cited in the local coverage policy.  Check with your Medicare Administrative Contractor (MAC) for specific coverage limitations in your area.

This FAQ addresses the following:

  1. What are fundus photographs?
  2. Is fundus photography covered by Medicare and other third party payers?
  3. What CPT code is used to report fundus photography?
  4. What documentation is required in the medical record to support a claim for fundus photography?
  5. What is the reimbursement for 92250?
  6. Is fundus photography bundled with other tests or services?
  7. What is Medicare’s supervision requirement for fundus photography?
  8. How often may fundus photography be repeated?
  9. What is the frequency of fundus photography in the Medicare program?
  10. If coverage of fundus photography is unlikely or uncertain, how should we proceed? 

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