Richard Pridham

Richard Pridham
Richard is President & CEO of Retina Labs.
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Demystifying Reimbursement for Diabetic Retinopathy Exams for Primary Care Physicians

Posted by Richard Pridham on Jan 7, 2019 9:00:00 AM

On November 1, 2018, the Centers for Medicare and Medicaid (CMS) issued final rules for updating the 2019 Medicare Physician Fee Schedule to implement recent telehealth-related legislative reforms. Together, these rules represent a substantial expansion of Medicare reimbursement for services provided via telehealth. However, for ocular telehealth, particularly as it applies to Diabetic Retinopathy Exams (DRE), the situation remains somewhat misunderstood.

One of the frequent questions we get asked pertains to reimbursement for telemedicine-based Diabetic Retinopathy Exams (DRE). This involve a scenario where a patient receives a retinal exam in their primary care physician’s office with fundus images being interpreted by a qualified eye care professional (e.g. ophthalmologist or optometrist) at a remote site using a store and forward method. What are the CPT codes for this procedure and how much they pay?

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Topics: Best Practice

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