On this page
Key takeaways
- 92250 covers fundus photos of one or both eyes, billed once per date with no RT, LT or modifier 50.
- The photos must document a condition and change or support management, not serve as a routine screening.
- 92250 is mutually exclusive with extended ophthalmoscopy (92201 and 92202) and remote retinal imaging (92227 to 92229).
- The code has professional and technical components, billed with modifier 26 or TC when the work is split.
What Is CPT Code 92250?
CPT 92250 is the code for fundus photography with interpretation and report, used to photograph and document disease in the retina, optic nerve and retinal vessels. It is one of the diagnostic test codes in the ophthalmology CPT codes list.
The table sums up the billing facts that apply to every 92250 claim.
| Billing fact | 92250 |
|---|---|
| Units per date | 1, for one or both eyes |
| Laterality modifier | None, the code is bilateral by definition |
| Components | Professional (26) and technical (TC) |
| Mutually exclusive with | 92201, 92202, 92227, 92228, 92229 |
| 2026 Medicare national office amount | About $37 before geographic adjustment |
The photos are taken with a fundus camera or a widefield imaging system, and the doctor's written interpretation is part of the code.
When Is Fundus Photography Medically Necessary?
Fundus photography is medically necessary when the photos document a retinal or optic nerve condition and the results are used to manage it. Medicare does not pay for 92250 as a routine screening or as a replacement for a dilated exam.
These are the conditions where 92250 is billed most often.
- Diabetic retinopathy, to record the stage and compare over time
- Macular degeneration, to track drusen, atrophy or a scar
- Choroidal nevus or suspected melanoma, to measure change in size
- Glaucoma, to record the appearance of the optic nerve
- Retinal vein or artery occlusion and hypertensive retinopathy
The diagnosis on the claim should match the reason for the photos, such as a complete code from the ophthalmology ICD-10 codes list.
Which Codes Cannot Be Billed With 92250?
92250 cannot be billed on the same date as extended ophthalmoscopy (92201, 92202) or remote retinal imaging (92227 to 92229), because NCCI treats them as mutually exclusive. Only one of the codes in each pair is paid.
| Code pair | Rule | What to bill |
|---|---|---|
| 92250 with 92201 or 92202 | Mutually exclusive | The test that answers the clinical question |
| 92250 with 92227, 92228 or 92229 | Mutually exclusive | One imaging code per date |
| 92250 with 92134 | No national edit, some payer limits | Both only when each has its own purpose |
| 92250 with an eye exam | Billed separately | The exam and 92250, when the photos are medically necessary |
OCT and fundus photos often answer the same question, so payers look closely at claims that bill both. Write why each test was needed.
How Is 92250 Billed for One or Both Eyes?
92250 is billed as 1 unit per date with no laterality modifier, whether one eye or both eyes are photographed. Medicare treats the code as already bilateral.
Some payers want modifier 52 when only one eye is photographed, because less work was done. Others pay the full code. Load each payer's rule into the billing system so that the claim goes out the right way.
How is 92250 split between two providers?
When one provider takes the photos and another reads them, the provider who reads them bills 92250-26 and the owner of the equipment bills 92250-TC. A practice that does both bills 92250 with no component modifier.
What Must the Fundus Photography Report Include?
The report must name the findings for each eye photographed, compare them with earlier images when available and state how the results affect the plan. A report that only says "photos taken" does not support payment.
- Order. The reason for the photos, written by the treating provider.
- Findings. What the photos show in each eye.
- Comparison. Stable, better or worse than earlier images.
- Plan. How the results change or support management.
The report should be signed and dated by the provider who read the photos.
What Does a 92250 Claim Look Like?
A 92250 claim bills the code once, with 1 unit and a diagnosis that the photos help manage. The example shows a diabetic patient seen for a follow-up exam with photos of both eyes.
| Claim line | Units | Diagnosis |
|---|---|---|
| 92014 | 1 | E11.3293, type 2 diabetes with mild nonproliferative retinopathy, no macular edema, both eyes |
| 92250 | 1 | E11.3293 |
The exam and the photos are both paid when the record supports each one.
Why Do 92250 Claims Deny?
92250 claims deny most often because of a same-day conflict with another imaging code, a screening diagnosis or a missing report. These checks catch most of them.
- 92250 billed with 92201, 92202 or remote retinal imaging on the same date
- A routine or screening diagnosis with no documented condition
- RT, LT or modifier 50 added to the line
- No signed interpretation and report
- Photos repeated more often than the condition's change justifies
Our retina billing services and ophthalmology medical coding services teams check every imaging claim against these edits before it is sent.