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

Medicare covers fundus photography (CPT 92250, 92228) and extended ophthalmoscopy (CPT 92201, 92202) when medical necessity is documented, including specific records (photographs, interpretation, retinal drawings). CPT 92227 (remote retinal screening) is considered screening and non-covered (submit with modifier GY); billing modifiers and documentation requirements (no LT/RT/50 on certain bilateral codes, 26/TC use only where appropriate, ABN/G-modifier rules) and per-eye frequency limits (up to 12/year for H35.32, up to 6/year for listed neoplastic codes) must be followed.

"Fundus photography (CPT 92250, 92228) is covered when medical necessity is documented in the patient's medical record including relevant history, physical exam, results of pertinent tests, an inter..."

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