Medicare Reimbursement for Imaging with the SPECTRALIS (Heidelberg)

This monograph describes reimbursement for fundus photography (FP), fluorescein and indocyanine angiography (FA and ICG), as well as scanning computerized ophthalmic diagnostic imaging of the anterior (SCODI-A) and posterior segments of the eye (SCODI-P) using Heidelberg Engineering’s SPECTRALIS® instrument and its associated add-on modules.

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 these tests, as well as recent Medicare utilization rates.

 

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