S0625
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Retinal telescreening systems in the outpatient setting are consideredmedically necessaryfor annual diabetic retinopathy screening as an alternative to retinopathy screening by an ophthalmologist or optometrist whenbothof the following criteria are met:
- The individual does not have prior known diabetic retinopathy;and
- The imaging and grading technique is performed with a U.S. Food and Drug Administration (FDA) approved device for retinal telescreening.
1 Active Policy
ANTHEM-CG-MED-35 — CG-MED-35 Retinal Telescreening Systems
Related Codes
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