CPT Code 92250: Fundus 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
$35 to $70 (global)
National averages only. Rates vary by locality, payer, and fee schedule. Verify with your contracted payers.
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
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