MAR 01, 2020
Frequency of Billing Fundus Photography
Question: Our physician heard that he should not be submitting CPT code 92250 Fundus Photography more than twice per year. However, he feels there are times when additional billings may be necessary. Can you confirm the frequency of billing fundus photos?
Answer: Not every MAC has a policy on fundus photos. Those that do, like National Government Services, indicate the following: Fundus photography is usually medically necessary no more than two times per year. Most payers, including other MACs, follow this language. If your physician feels it is medically necessary to perform more often, obtain an advance beneficiary notice (ABN) and submit 92250 with modifier -GA for Medicare Part B. The patient will likely be financially responsible for the test.
You can find Medicare Part B policies at aao.org/lcds.