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

Fundus photography is covered when photographs and a written interpretation/report are necessary for diagnosis, monitoring, or treatment planning of retinal and posterior segment disease (e.g., diabetic retinopathy, macular degeneration, retinal neoplasms). Extended ophthalmoscopy is covered when a detailed posterior segment exam and documentation beyond routine ophthalmoscopy are required for medical decision making (e.g., retinal detachment, intraocular foreign body, vitreous disorders, endophthalmitis, glaucoma). Coverage requires documentation (interpretation/report and, for indirect ophthalmoscopy, a retinal drawing), is not payable for screening or routine exams, and repeated or fellow-eye exams without documented change are subject to denial.

"Fundus photography is covered to document abnormalities or disease processes of the retina when photographs and an interpretation/report are necessary for diagnosis, monitoring, or treatment planning."