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Medicare Reimbursement for External Photography

Topic: External Photos

Sponsor: Corcoran Consulting Group

Updated: 01/20/2020

Corcoran Consulting Group

External photography documents the external eye, lids and ocular adnexa.  Photographs can record conditions and pathology of the adnexa, external eye and anterior segment more accurately than chart notes or drawings.  They are used to track changes in patients’ conditions over time.

Most Medicare LCDs contain a variety of valid diagnoses for external photos. The lists vary, but usually include diagnoses related to external and anterior segment diseases involving the lids, lacrimal system, cornea, conjunctiva, anterior chamber and iris.

This FAQ addresses the following:

  1. What is external photography?
  2. What CPT code should we use to describe this test?
  3. What diagnoses support a claim for external photography?
  4. Is the physician’s presence required while external photography is being performed?
  5. What documentation is required in the medical record to support claims for external photography?
  6. Does Medicare cover external photography?
  7. What does Medicare allow for external photography?
  8. What is the frequency of external photography in the Medicare program?
  9. How often may this test be repeated?
  10. Is external photography bundled with other services?
  11. If coverage of external photography is unlikely or uncertain, how should we proceed?