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Wiki Billing CPT code 92250 at an FQHC
- Thread starter jgielow
- Start date
1st questions is what insurance are you trying to bill?
Below is the link to CMS FQHC billing codes that qualify as an FQHC visit.
Below is the link to CMS FQHC billing codes that qualify as an FQHC visit.
IndepCoder
Networker
Does Medicare cover fundus photography using Topcon’s fundus cameras and imaging systems?I am being told by our billing company that an FQHC is unable to bill for the 92250. Can anyone confirm this? Or point me in the right direction? I am very new to FQHC billing and I am completely lost. Thank you
A Ophthalmic imaging is covered by Medicare subject to the limitations in its payment policies; other third party payers generally agree. Medicare covers fundus photography if the patient presents with a complaint that leads you to perform this test or as an adjunct to management and treatment of a known disease. If the images are taken as baseline documentation of a healthy eye or as preventative medicine to screen for potential disease, then it is not covered (even if disease is identified). Also, this test is not covered if performed for an indication that is not cited in the local coverage policy. Check your local policies; they vary.
corcoran.com
Also Depending on the billing type of FQHC it could fall under Medicare part B for your cost report, Also has frequency limits, and it is bundled with other test codes i.e 92133 92134 92240
What documentation is required in the medical record?
In addition to the photos or proof that digital images exist, the chart should contain:
- an order for the test with medical rationale
- the date of the test
- the reliability of the test (e.g., cloudy due to cataract)
- the test findings (e.g., hemorrhage)
- comparison with prior tests (when applicable)
- a diagnosis (if possible)
- the impact on treatment and prognosis
- the signature of the physician