Medicare Reimbursement for Imaging with Topcon OCT Instruments (Topcon Medical Systems)

This monograph describes reimbursement for fundus photography (FP), fluorescein angiography (FA), and scanning computerized ophthalmic diagnostic imaging of the posterior segment of the eye (SCODI-P, aka OCT) using Topcon Medical System’s DRI OCT TRITON and DRI OCT TRITON (plus) as well as the spectral-domain, 3D OCT OCT-1 Maestro instrument. FP, FA, and SCODI-P are common ophthalmic diagnostic tests that are useful for medical monitoring, screening, and telemedicine. The two DRI OCT Triton instruments are also capable of scanning computerized ophthalmic diagnostic imaging of the anterior segment (SCODI-A).

Much of the information in this document is taken from official publications of the Medicare program. The reader is encouraged to check with the local Medicare Administrative Contractor (MAC) for additional information and instructions. For other third party payers, we have used the coding concepts contained in CPT and published by the American Medical Association; diagnosis codes are from ICD-10-CM.

Documentation of diagnostic tests, and the medical rationale for them, is key to reimbursement so we describe the required elements in detail. Since economic analyses are a necessary part of any capital budgeting decision, we incorporated Medicare’s payment rates for fundus imaging, as well as recent Medicare utilization rates.



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Provided Courtesy of Topcon Medical Systems, Inc.


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