CG-MED-47 Fundus Photography

This policy addresses fundus photography of the eye. It is covered when medically necessary to document abnormalities or active disease and to monitor progression when results will guide therapy and improve outcomes; examples include diabetic retinopathy, glaucoma/glaucoma suspects, retinal detachment/defects, ocular infections, trauma/foreign body, pseudotumor cerebri, congenital posterior segment anomalies, color vision abnormalities, or abnormal EOG/oculomotor findings. It is not covered for screening (including retinopathy screening in patients on chloroquine or hydroxychloroquine) or when criteria are not met, and computer-based superimposed time-lapse imaging (e.g., MatchedFlicker) is not covered for monitoring or any indication.

"Fundus photography is consideredmedically necessaryto document abnormalities or disease processes (not screening) affecting the eye or to follow the progress of such eye disease when the results of..."