• 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 the PCP office for patients with known diabetic retinopathy to meet their HEDIS requirements. Isn’t this 92250 Fundus photography appended with modifier –26?

    Answer: This is an example of telehealth. For patients with known retinopathy:

    • 92228 –26 billed by the ophthalmologist $21.06
    • 92228 –TC billed by the PCP $13.78
    • Do not report 92250 –26 for telemedicine $22.51