Fundus Photography Reimbursement

Topic: Fundus Photos

Sponsor: Optovue

Updated: 01/28/2020


This monograph describes reimbursement for fundus photography using Optovue’s iCam® compact fundus camera, or iFusion™ combination Spectral-Domain OCT and fundus camera. Fundus photography is a common ophthalmic diagnostic test that is useful for medical monitoring, screening, and telemedicine.

Much of the information in this document is taken from official publications of the Medicare program. The reader is encouraged to check with the local Medicare Administrative Contractor (MAC) for additional information and instructions. For other third party payers, we have used the coding concepts contained in CPT and published by the American Medical Association; diagnosis codes are from ICD-10-CM. Documentation of a diagnostic test, and the medical rationale for it, are key to reimbursement so we describe the required elements in detail.

Since economic analyses are a necessary part of any capital budgeting decision, we incorporated Medicare’s payment rates for fundus imaging, as well as recent Medicare utilization rates.