Medicare Reimbursement for Fundus Photography with the Clarus 500

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Topic: Fundus Photos

Sponsor: ZEISS

Updated: 02/17/2021

This FAQ addresses the following:

What is the CLARUS 500 ultra-widefield fundus imaging system, and what is it used for?
Will Medicare cover this test?
What documentation is required in the medical record?
Will FP be reimbursed if performed on the same day as an eye exam or another diagnostic test?
Is the physician’s presence required while fundus photography with CLARUS 500 is being performed?
How much does Medicare allow for this test?
How often may FP be repeated on a patient?
What is the frequency of FP in the Medicare program?
If coverage is unlikely or uncertain, how should we proceed?

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The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.

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