Kristen Posted Wed 23rd of February, 2011 18:55:02 PM
92250 Are there any maximum limits that the fundus photos may be done? i.e. 1 x yearly VS 4 X yearly?
SuperCoder Answered Wed 23rd of February, 2011 20:55:37 PM
Answer is not specific.
The frequency for which Medicare reimburses for the test depends on the local coverage determination and coding guidelines, and is diagnosis-driven.
As per coding guidelines:
Medicare covers fundus photography if the patient presents with a complaint that leads you to perform this test, or as an adjunct to management and treatment of a known disease. If you take the images as baseline documentation of a healthy eye or as preventative medicine to screen for potential disease, then Medicare won't cover it (even if you identify a disease). Medicare also won't cover this test if you perform it for an indication that isn't cited in the local medical review policy. Check with your carrier for specific coverage limitations.
Fundus photography (92250) is considered mutually exclusive with 92135. This means that you will be paid for the fundus photos instead of the 92135 if both are performed and billed on the same day.