Medicare Reimbursement for Imaging with the Topcon 3D OCT-1 Maestro

This monograph describes reimbursement for fundus photography (FP) and scanning computerized ophthalmic diagnostic imaging of the posterior segment of the eye (SCODI-P) using Topcon Medical System’s 3D OCT-1 Maestro instrument. Both FP and SCODI-P are common ophthalmic diagnostic tests that are useful for medical monitoring, screening, and telemedicine.

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-9-CM and 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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