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  • 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.