Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

Medicare covers fundus photography and extended ophthalmoscopy when medical necessity is documented in the medical record, including history, exam, pertinent test results, and retention of images/reports; extended ophthalmoscopy requires retinal drawings per Appendix A and specific documentation for glaucoma. Frequency limits apply: fundus photography generally ≤2 times/year, extended ophthalmoscopy up to 12/eye/year for active intravitreal treatment of exudative AMD, up to 6/eye/year for specified infectious/diabetic/inflammatory conditions, up to 4/eye/year for neoplasms, and usually ≤2/eye/year for other conditions; services outside these parameters or routine/bundled exam components are noncovered.

"Fundus photography is covered when medical necessity is documented in the medical record, including relevant history, exam, diagnostic test results, and retention of the photographs and an interpre..."