Wiki 92285 for WPS Medicare


Grand Rapids, MI
Best answers
When questioning why a provider group wasn't billing 92285 ocular photography to WPS Medicare the provider responded they had previously found these were not payed by WPS Medicare & gave the 2 links below. I do see that there is an NCCI edit between 15823 & 92285 but are they still considered bundled or non-billable when photos are done at the initial visit? I can't find any LCD or coding articles on 92285 for WPS Medicare.

From under the Pre-Op Exam heading:

WPS: Visual fields required. WPS emphasizes that photographs are not separately billable to Medicare.

From under the Article Guidance heading:

8. Photographs are not separately billable to Medicare.
CMS requirements indicate external photos are required, but the LCD (none found from WPS) for external photos does not list dermatochalasis or lid ptosis as supportive of medical necessity.
Our practice codes the photos, but doesn't bill insurance for them.
Our contractor is Novitas, and my previous practice was under First Coast. Both those contractors have very limited covered diagnosis for external photos.