Retinal photography or fundus photo billing (CPT 92250) can be tricky. Although optometrists understand the value of routine screening with a retinal camera, most payers will not pay unless there is a documented medical condition that was notated in the record before the test was run. Running a screening and finding retinopathy is still considered a screening.

The best way to handle this is to think of retinal screening and retinal diagnostic imaging as two different services. Upon check-in, the front desk staff should explain to the patient the value of a retinal screening even if there is no history of retinopathy. It is useful to have a form that briefly explains this. The patient can then choose to opt-in to the screening and pay the private payer price (since there is no insurance price) or opt-out and pay nothing. When charging for a screening, use a code other than 92250 (make one up for your system) so that you can prove to any auditors that you are not providing screening services at diagnostic prices.



Back to FAQs search results