Digital Imaging Systems for the Detection and Evaluation of Diabetic Retinopathy

Section: Diagnostic Medical
Effective Date: May 01, 2020
Revised Date: March 16, 2020
Last Reviewed: March 16, 2020

Description

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.


Criteria

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.

Procedure Codes

92227 92228

 

Intraocular photography may be considered medically necessary when used for the diagnosis of such conditions as (not an all-inclusive list):

  • Macular degeneration; or
  • Retinal neoplasms; or
  • Choroid disturbances; or
  • Diabetic retinopathy; or
  • To identify Glaucoma; or
  • To identify Multiple sclerosis; or
  • To identify other central nervous system abnormalities.

Intraocular photography is considered not medically necessary for all other indications.

Procedure Codes

92250


Diagnosis Codes

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

 

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 3-16-2020 added indications for Intraocular Photography 92250

Links

Disclaimer

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.