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Reimbursement for Fundus Photography in Telemedicine

Topic: Fundus Photo

Sponsor: Corcoran Consulting Group

Updated: 07/31/2018

Corcoran Consulting Group

Telemedicine is the remote diagnosis and management of patients by means of telecommunication technology. In eye care, digital fundus photography (FP) lends itself to successful telemedicine1 because the camera can be placed in a primary care physician’s (PCP’s) office and operated by the PCP’s staff. Then, the images are transmitted to an ophthalmologist or optometrist for interpretation. Patients benefit from access to specialists who are not otherwise available.2,3,4,5 This monograph addresses the multitude of legal and regulatory issues pertinent to screening for retinal diseases using a non-mydriatic fundus camera in the context of asynchronous telemedicine. We describe the challenges and offer a possible pathway forward to overcome or mitigate the obstacles.

Much of the information in this document is taken from official publications of the Medicare program, including the Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MACs). However, the reader is encouraged to check with the local MAC and other third party payers for additional information and instructions. We have used the coding concepts contained in Current Procedural Terminology (CPT) as published by the American Medical Association; diagnosis codes are from International Classification of Diseases 10th Revision (ICD-10-CM).