CPT 92250Fundus Photography
Fundus photography with interpretation and report
CPT 92250 reports fundus photography, including interpretation and written report. Used to document retinal or optic nerve pathology and for longitudinal comparison in managing chronic eye diseases.
When to use CPT 92250
Use when fundus photos are taken for a medical indication (diabetic retinopathy, glaucoma, macular degeneration, suspicious lesion, optic neuropathy). Must include written interpretation.
Documentation requirements
- Medical indication documented
- Interpretation and report (cannot bill without it)
- Comparison with prior imaging when applicable
Reimbursement
Use the current payer fee schedule for this code, locality, service setting and date of service.
Rates and patient responsibility depend on the payer and service. No unsourced national average is presented here.
Common modifiers
- -TC (technical component)
- -26 (professional component)
- -52 (reduced services)
Common denial reasons for CPT 92250
- Missing interpretation and report
- Not medically necessary
- Frequency limit exceeded
- Same-day bundling with exam
Verify CPT 92250 against official sources
Use the code set and payer policy applicable to the date of service. This educational reference is not a coverage decision or a substitute for a qualified coding review.
- CMS Physician Fee Schedule: select the year, locality and service setting before looking up payment information.
- CMS NCCI edits and manuals: check the applicable code-pair edits and modifier instructions.
- Medicare Coverage Database: find relevant coverage and documentation policies.
- AMA CPT resources: consult the current licensed code set.
A practical documentation check
- Match the documented service to the code definition.
- Confirm patient status, laterality, components and any required interpretation.
- Check coverage, edits and payer-specific requirements.
- Have the responsible clinician or billing reviewer resolve discrepancies before submission.
Editorial sources updated September 15, 2026. Published by Jelo.
Jelo’s AI scribe is an upcoming add-on from $70/month. It is being developed to assist with documentation and code suggestions; clinicians and billing staff must verify every code. It is not included in the live platform subscription.
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