MAY 06, 2019
Telehealth Retinal Codes
Question: Our primary care group has a fundus camera. They want to perform the test and have our physician provide the interpretation and report. How do we submit these services?
Answer: These services would be submitted using the telemedicine codes created for detection of retinal disease.
- Screening patients with no known retinopathy.
- 92227 Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral (average allowable $15.24)
- No -26/-TC split.
- Either the PCP or the ophthalmologist can bill with 92227 and collect the entire amount. A separate contract with the other provider for their portion is appropriate.
- For patients with known retinopathy:
- 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 billed by the PCP (average allowable $13.78)
- Do not report 92250 -26 for telemedicine
- What about CPT code 92250 Fundus photography?
- For Medicare Part B, do not report 92250 -26 for telemedicine. (average allowable $22.51)
- CPT code 92228 that describes this service
- Billing 92250 incorrectly increases utilization significantly
- What about commercial plans that have published policies state 92250 -26 is appropriate? Follow the rules of the commercial payer.
Learn more about reporting retinal codes in Retina Coding: Complete Reference Guide.