Medicare Reimbursement for Ophthalmic Telemedicine

Telemedicine is the remote diagnosis and treatment of patients by means of telecommunication technology. In eye care, digital fundus photography lends itself to telemedicine because the camera can be placed in a primary care physician’s (PCP) office and be operated by the PCP’s staff. Then, the images are transmitted to an ophthalmologist or optometrist for interpretation. Patients benefit from access to specialists who are not otherwise available locally.

This FAQ addresses the following:

1. What is telemedicine?
2. Are there CPT codes for ophthalmic telemedicine?
3. Who uses these codes?
4. What is the difference between these codes?
5. Does Medicare cover these services?
6. Are there any coding bundles or other limitations?
7. Must a physician be present while these tests are being performed?
8. What is the reimbursement for these codes?

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