CPT Code 92250: Fundus Photography with Interpretation and Report

Know more about the documentation requirements and billing guidelines needed for accurate coding and billing of CPT code 92250.

Use Code

What is the 92250 CPT code?

CPT code 92250 describes fundus photography with interpretation and report, a diagnostic imaging procedure used to capture high-resolution images of the posterior segment of the eye, including the retina, optic nerve head, macula, and posterior pole.

This service is essential for diagnosing and monitoring retinal disorders and conditions such as retinopathy caused by diabetes mellitus, glaucoma, age-related macular degeneration, hypertensive retinopathy, and optic neuritis.

The procedure is typically performed with a non-mydriatic or mydriatic fundus camera. It includes the technical capture of the image and the professional interpretation by an ophthalmologist or optometrist, documented in the patient’s medical record.

CPT code 92250 documentation requirements

To support the claim for fundus photography, the documentation for CPT code 92250 must include:

Medical necessity and diagnosis (e.g., diabetic retinopathy, AMD)
Date and reliability of the test
Type of fundus camera used (mydriatic vs. non-mydriatic)
Eye(s) imaged (OD, OS, or both)
Quality of image and adequacy for diagnostic purposes
Detailed interpretation of fundus photographs with findings and clinical relevance
Comparison with prior tests (if applicable)
Signed written report as part of the medical record

The report must demonstrate that the image was interpreted in a clinically meaningful way, influencing treatment decisions.

CPT code 92250 billing guidelines

For accurate medical billing and to minimize the risk of audits and penalties for CPT code 99250, follow the guidelines provided below:

Report once per session, regardless of whether one or both eyes are photographed. Do note to append the appropriate -LT or -RT modifiers if a unilateral service is performed.
The procedure is considered a diagnostic test, not a general screening tool. Imaging of a normal retina is typically deemed not medically necessary.
Modifier -TC (technical component), -26 (professional component), or any other relevant modifiers like -59, -22, etc., may be used if billing separately
Not separately billable when bundled with certain comprehensive ophthalmic exams or in global periods of surgeries unless medically indicated.
A physical examination and related findings often support the need for imaging, and compliance with local coverage determination (LCD) policies is essential for appropriate billing.

Payers may deny claims if there’s no clear medical necessity or if the procedure is performed as part of a screening.

Other relevant CPT codes

92133: Computerized ophthalmic diagnostic imaging of the optic nerve
92134: Diagnostic imaging of the posterior segment of the eye
92083: Extensive visual field examination
92228: Remote imaging for monitoring and management of active retinal disease

Frequently asked questions

No. Fundus photography must be medically necessary for diagnosis or monitoring; routine screenings are not covered.

Not for the same condition in the same eye unless separately indicated and well-documented. For example, if macular edema is present in one eye and a different pathology in the other, documentation must clearly support medical necessity for both tests.

Yes. Interpretation and a signed report are mandatory for reimbursement.