Reimbursement for Fundus Photography

Medicare will reimburse you for fundus photography if the patient presents with a complaint that leads you to perform this test as an adjunct to evaluation and management of a covered indication. If the images are taken as baseline documentation of a healthy eye or as preventative medicine to screen for potential disease, then the test is generally not covered (even if disease is identified). Also, it is not covered if performed for indications not in the local coverage policy.

This FAQ addresses the following:

1. What is fundus photography?
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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