• Billing Interpretation of Fundus Photos


    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. For patients with known retinopathy:

    • 92228 -26 is billed by the ophthalmologist.
    • 92228 -TC is billed by the PCP.
    • Do not report 92250 -26 for telemedicine.

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