Can a Primary Care Provider bill 92250?

cdiaz

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We are billing routine/diagnostic fundus photographs for diabetic patients but keep receiving denials from the insurance stating the provider does not match the billable code. I see there have been code changes for 2021 with 92227, 92228, 92229. My thought is we bill 92229 instead.
We own the machine that does the test and we pay the ophthalmologist to read them so he does not bill insurance for his service.
Can anyone tell me what is the corretc code to bill?
Thanks
 

SharonCollachi

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Most likely, the insurance in question requires an opth specialty to bill for those services. You'll need to contact them and ask.
 
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We are billing routine/diagnostic fundus photographs for diabetic patients but keep receiving denials from the insurance stating the provider does not match the billable code. I see there have been code changes for 2021 with 92227, 92228, 92229. My thought is we bill 92229 instead.
We own the machine that does the test and we pay the ophthalmologist to read them so he does not bill insurance for his service.
Can anyone tell me what is the corretc code to bill?
Thanks
We recently started performing retinopathy screenings in our clinic using 92250 and haven't had any issues expected for an off the wall, small insurance group. The diagnosis is one of the keys to getting payment. The patient must have a dx of diabetes in order for it to be covered.
 

twalls

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We are also billing 92250 for our PCP's doing fundus. We have had difficulty with Medicare but there are LCD's that want additional DX other than just a diabetes DX- check those, but other than them and a few outliers we have received payment.
 
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