Medicare Reimbursement for Fundus Photography

Topic: Fundus Photos

Sponsor: ZEISS

Updated: 11/22/2019


This monograph describes reimbursement for digital fundus imaging with fundus cameras from Carl Zeiss Meditec, Inc. For the purposes of procedure coding on claims for reimbursement, this imaging is identified in a number of different ways depending on context:

  • fundus photography,
  • autofluorescent imaging,
  • remote imaging,
  • fluorescein angiography (FA), or
  • indocyanine green (ICG) angiography.

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.
Documentation of diagnostic tests, and the medical rationale for them, 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, as well as recent Medicare utilization rates.