Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

Fundus photography is covered when it contributes to medical decision making by monitoring disease progression or guiding a specific treatment or response, but is not covered for routine screening or for baseline documentation of static conditions. Extended ophthalmoscopy is covered for a broad set of retinal, choroidal, vitreous, traumatic, inflammatory, neoplastic, and glaucoma-related indications when a more detailed retinal examination (including a required retinal drawing) performed by a physician is needed; repeated or contralateral exams without new signs or symptoms are not covered. All studies require a written interpretation in the same medical record and fundus photos used to guide treatment should be ordered by the treating physician.

"Fundus photography is medically necessary when it will assist in monitoring progression of an eye disease or in guiding the need for or response to a specific treatment or intervention."