Medicare Reimbursement for Fundus Photography

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Topic: Fundus Photos

Sponsor: Nidek

Updated: 04/24/2018

This FAQ addresses the following:

What is fundus photography?
Is fundus photography performed with Nidek’s AFC-330 and DS-20 covered by Medicare and other payers?
What CPT code is used to describe fundus photography?
What documentation is required in the medical record to support a claim for fundus photography?
How is fundus photography reimbursed?
What is Medicare’s supervision requirement for fundus photography?
Is fundus photography bundled with other tests or services?
How often may we repeat this test?
What is the frequency of fundus photography in the Medicare program?
If coverage of fundus photography 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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