Question: In our rural community, primary care physicians are asking us to provide the interpretation and report on photos taken in their office for patients with known diabetic retinopathy to meet their Healthcare Effectiveness Data and Information Set (HEDIS) requirements. Isn’t this 92250 Fundus photography appended with modifier -26?

Answer: No. This is an example of telemedicine and should be billed using CPT code 92228 Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral.  

• 92228 -26 billed by the ophthalmologist (average allowable $21.06)
• 92228 -TC is billed by the PCP (average allowable $13.78)
• Do not report 92250 -26 for telemedicine

Learn more about testing services in Retina Coding: Complete Reference Guide.