92250_R10

The performance of fundus photography for specific conditions may be performed as often as reasonable and necessary to make clinical decisions in the treatment of the condition.  All documentation should be legible, maintained in the patient’s medical record and available to Medicare upon request.

The patient’s medical record must contain documentation that fully supports the medical necessity for fundus photography as it is covered by Medicare.  This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

A copy of the fundus photographs must be retained in the patient’s medical records.  An interpretation and report of the test must also be included, in addition to the photographs themselves.  The medical record should also document whether the pupil was dilated for the procedure.

1. Report fundus photography with CPT code 92250.  This is a bilateral test, therefore no modifiers are required if both eyes are examined. 

2. Fundus photography is a bilateral service on the Medicare Physician Fee Schedule Database.  Services performed unilaterally are subject to a reduction in fee.  Use –52 modifier to indicate unilateral service; -RT and –LT are not required in this circumstance. 

3. Fundus photography requires general supervision by the optometrist/ophthalmologist.

4. An eye examination may be reported on the same day as fundus photography if it is medically necessary.

Limitations

All tests must include a written interpretation.  If an interpretation is not included in the same medical record with the photograph, then both the technical and professional components will be considered not medically necessary.

Fundus photography of a normal retina will be denied as not medically necessary.

This Medicare carrierhas no specific utilization guidelines for fundus photography.  In the absence of specific utilization guidelines, optometrists and ophthalmologists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of optometric practice.