Medicare Policy on Screening Fundus Photography

Topic: Screening

Sponsor: Nidek

Updated: 04/24/2018

Nidek

This FAQ addresses the following:

  1. Does Medicare cover fundus photography performed with Nidek’s AFC-330 and DS-20?
  2. If the patient pays for a screening photo and pathology is found, may a claim be submitted to Medicare?
  3. If the patient does not pay for a screening photo and pathology is found, may a claim be submitted to Medicare?
  4. If we perform screening fundus photos and find pathology, when are additional fundus photos warranted?
  5. What are the attributes of a screening program?
  6. Why do some cameras have two modes: screening and medical?
  7. If a high resolution photo is taken on the same day as a low resolution screening photo, is a claim warranted?
  8. Does analysis of a photo justify an additional charge?
  9. Do Medicare’s regulations regarding fundus photography apply to both ophthalmologists and optometrists?
  10. What documentation is required in the medical record?
  11. Do other third party payers follow Medicare’s coverage and payment policies?
  12. How do we document the patient’s acceptance of financial responsibility for screening photos?