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

Fundus photography is covered when used to document, diagnose, or follow retinal or choroidal disease and when images and a written interpretation/report are used in medical decision making. Extended ophthalmoscopy is covered when a complete posterior-segment view and greater documentation than general ophthalmoscopy are needed for specific clinical conditions (e.g., retinal detachment, intraocular foreign body, severe inflammatory or neoplastic disease, diabetic retinopathy, glaucoma), but both imaging types are denied when performed purely for screening, when documentation (interpretation or required drawing) is missing, when duplicative without expectation of added information, or when performed in unsupported repetitive fashion.

"Fundus photography is indicated to document abnormalities of the retina or choroid or to follow the progression of retinal or choroidal disease when the images will be used in medical decision making."