Fundus Photography Reimbursement

Topic: Fundus Photos

Sponsor: epipole

Updated: 03/28/2023


This monograph describes reimbursement for fundus photography using epipole’s epiCam portable fundus camera. Fundus photography is a common ophthalmic diagnostic test 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 the CPT Professional Codebook, published by the American Medical Association; diagnosis codes are from ICD-10-CM. Documentation of a diagnostic test and its medical rationale is 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 and recent Medicare utilization rates.