A digital fundus camera is used to acquire a series of standard field color images and/or monochromatic images of the retina of each eye in the physician's office. These photos are then transmitted to a remote center for interpretation by an ophthalmologist specialist for interpretation as well as recommendations for treatment.
Retinal telescreening by digital imaging, using an FDA-approved digital imaging system,may be considered medically necessary for the detection andevaluation of diabetic retinopathy for individuals with diabetes mellitus.
Retinal telescreening is considered not medically necessary for all other indications, including the monitoring and management of disease in individuals diagnosed with diabetic retinopathy.
| 92227 | 92228 |
Intraocular photography may be considered medically necessary when used for the diagnosis of such conditions as (not an all-inclusive list):
Intraocular photography is considered not medically necessary for all other indications.
92250 |
Covered diagnosis codes for procedure codes 92227 and 92228
| E08.8 | E08.9 | E08.00 | E08.01 | E08.10 | E08.11 | E08.21 |
| E08.22 | E08.29 | E08.36 | E08.39 | E08.40 | E08.41 | E08.42 |
| E08.43 | E08.44 | E08.49 | E08.51 | E08.52 | E08.59 | E08.65 |
| E08.69 | E08.610 | E08.618 | E08.620 | E08.621 | E08.622 | E08.628 |
| E08.630 | E08.638 | E08.641 | E08.649 | E09.8 | E09.9 | E09.00 |
| E09.01 | E09.10 | E09.11 | E09.21 | E09.22 | E09.29 | E09.36 |
| E09.39 | E09.40 | E09.41 | E09.42 | E09.43 | E09.44 | E09.49 |
| E09.51 | E09.52 | E09.59 | E09.65 | E09.69 | E09.610 | E09.618 |
| E09.620 | E09.621 | E09.622 | E09.628 | E09.630 | E09.638 | E09.641 |
| E09.649 | E10.8 | E10.9 | E10.10 | E10.11 | E10.21 | E10.22 |
| E10.29 | E10.36 | E10.39 | E10.40 | E10.41 | E10.42 | E10.43 |
| E10.44 | E10.49 | E10.51 | E10.52 | E10.59 | E10.65 | E10.69 |
| E10.610 | E10.618 | E10.620 | E10.621 | E10.622 | E10.628 | E10.630 |
| E10.638 | E10.641 | E10.649 | E11.8 | E11.9 | E11.00 | E11.01 |
| E11.21 | E11.22 | E11.29 | E11.36 | E11.39 | E11.40 | E11.41 |
| E11.42 | E11.43 | E11.44 | E11.49 | E11.51 | E11.52 | E11.59 |
| E11.65 | E11.69 | E11.610 | E11.618 | E11.620 | E11.621 | E11.622 |
| E11.628 | E11.630 | E11.638 | E11.641 | E11.649 | E13.8 | E13.9 |
| E13.00 | E13.01 | E13.10 | E13.11 | E13.21 | E13.22 | E13.29 |
| E13.36 | E13.39 | E13.40 | E13.41 | E13.42 | E13.43 | E13.44 |
| E13.49 | E13.51 | E13.52 | E13.59 | E13.65 | E13.69 | E13.610 |
| E13.618 | E13.620 | E13.621 | E13.622 | E13.628 | E13.630 | E13.638 |
| E13.641 | E13.649 |
Not Applicable
Internal Medical Policy Committee 3-16-2020 added indications for Intraocular Photography 92250
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.