Eye Examinations in Diabetics
This article is to serve as a reminder that diabetic patients qualify for an annual eye examination as they are considered at high risk for diabetic retinopathy. This exam is covered when the examination is furnished by, or under direct supervision of, an ophthalmologist or optometrist, who is legally authorized to perform the services under State law (IOM - Pub 100-02, Ch 15, §280.1).
Retinal photography alone, including "telescreening," in the absence of a concurrent personal examination by an ophthalmologist or optometrist, is a screening test and, as such, is not covered by Medicare. Fundus photography is considered medically reasonable and necessary, and, therefore, covered, when furnished by an ophthalmologist or optometrist in the course of ocular evaluation and/or treatment (IOM - Pub 100-03, Ch 1, §80.6) Therefore, the digital imaging systems used for the detection of diabetic retinopathy, which acquire images and transmits them to a remote area for interpretation are considered screening and do not meet Medicare's reasonable and necessary criteria for reimbursement.
Page Last Updated: Tuesday, 15-Jul-2008 10:45:22 CDT
