Eye Care Coding Reference
CPT 92250 fundus photography.
What the code covers, why it is billed once for both eyes, how it relates to OCT, extended ophthalmoscopy and remote retinal imaging, what Medicare contractors say about coverage and what the interpretation and report should include. Last reviewed October 2026.
In one paragraph
The fundus photo code.
CPT 92250 covers photographs of the back of the eye taken to document or follow disease, with the doctor's interpretation and report. It is reported once whether one or both eyes are photographed. Medicare treats it as generally mutually exclusive with OCT of the optic nerve or retina (92133, 92134), and it is bundled with extended ophthalmoscopy (92201, 92202) and remote retinal imaging (92227 to 92229). Photos taken for screening a patient with no signs or symptoms are not a covered Medicare service. Descriptions on this page are Vision Rescue summaries, not the official CPT descriptor.
92250 at a glance
- One unit for one or both eyes
- Components: professional (26) and technical (TC)
- With 92133 or 92134: both only when each is needed for the same eye
- Bundled with extended ophthalmoscopy 92201 and 92202
- Screening photos are not covered by Medicare
- Repeat photos need a documented change or treatment decision
What 92250 covers.
The code describes medical photography of the retina and optic nerve, with a written reading by the doctor. Standard and wide-field fundus cameras are commonly reported with this code.
Part of the service
- Capturing the images, in one or both eyes
- The doctor's interpretation and a signed written report
- Keeping the images, or a reference to where they are stored, with the record
- Comparison with earlier photos when available
Professional and technical parts
| Modifier | Meaning |
|---|---|
| None (global) | The same practice takes the photos and interprets them |
| 26 | Professional component only: the interpretation and report |
| TC | Technical component only: the equipment, staff and images |
The test is performed under general supervision, so the doctor does not need to be in the room while photos are taken.
One unit for both eyes.
Medicare and most payers treat 92250 as a bilateral service. It is reported once whether one eye or both are photographed.
- No modifier 50 for photos of both eyes
- Photos of both eyes are still one unit of service
- Some payers have their own rules for one-eye photos; check the payer
- The record should show the reason for photographing each eye
Fundus photos with OCT and other tests.
Questions about 92250 are mostly about the same-day pairing with OCT. Medicare's 2026 NCCI manual explains the rule directly.
| Same encounter as 92250 | Rule | Source |
|---|---|---|
| 92134 retina OCT | Generally mutually exclusive. Both are paid only for a limited set of conditions where each is medically necessary for the same eye, with modifier 59 or XU on 92250. | NCCI Policy Manual 2026, Chapter 11 |
| 92133 optic nerve OCT | Same rule as 92134. | NCCI Policy Manual 2026, Chapter 11 |
| 92137 retina OCT with angiography | Listed among 92250's NCCI pairs in industry summaries of the 2026 edits. Check the current NCCI table. | NCCI edit tables |
| 92201 or 92202 extended ophthalmoscopy | Bundled with fundus photography on the same day. | NCCI edits; Retinal Physician |
| 92227 to 92229 remote retinal imaging | Bundled with 92250 on the same day. | NCCI edit tables |
| 92235 fluorescein angiography | A separate dye test with its own medical necessity. | CPT |
The NCCI manual says a doctor usually uses one technique or the other to evaluate the fundus. Medicare treats the posterior segment of one eye as a single anatomic site, so a modifier is not a routine way to report both tests. Several Medicare contractor SCODI LCDs add that the record must state why each test was needed when both are done the same day.
Medicare coverage and LCDs.
Fundus photography is covered when it documents or follows a condition. It is not covered as a screening test.
Generally supported
- A complaint or finding that leads to the test
- Following known disease such as diabetic retinopathy, macular degeneration or a nevus
- Documenting progression, new disease or the need for treatment such as laser
- Planning or evaluating a treatment
Generally not supported
- Screening a patient with no signs or symptoms, even if disease is found
- Baseline photos of a healthy eye
- Repeat photos of an unchanged condition with no new decision
First Coast retired its separate fundus photography LCD in 2020, and many contractors now address 92250 mainly within their SCODI LCDs, for example First Coast L33751, Novitas L35038, CGS L34061 and WPS L34760. Search the Medicare Coverage Database for your state to see whether your contractor has a billing article for 92250.
How often photos are expected.
There is no fixed national limit for 92250. Repeat photos follow medical need.
- Repeat photos are supported when disease progresses, new disease appears or treatment is being planned
- Photos of a stable, unchanged condition at routine intervals are a common audit concern
- Some contractors and plans publish their own frequency guidelines
- Each repeat should have a reason recorded in the order or the report
The interpretation and report.
The interpretation is part of the code. A one-word note such as abnormal is not enough, and missing reports are a frequent reason for recoupment.
- A dated order with the medical reason for the photos
- The date of the test and the image quality or reliability
- Findings for each eye photographed
- Comparison with prior photos when available
- The diagnosis and how the result affects treatment or prognosis
- The interpreting doctor's signature and date
The code itself did not change for 2026. The 2026 NCCI manual keeps the rule that fundus photography and OCT of the posterior segment are generally mutually exclusive. Medicare's 2026 fee schedule applied an efficiency adjustment to the work value of most non-time-based services, which may include diagnostic tests; check the 2026 fee schedule for your locality.
From Vision Rescue Pro
Supplies for medical and retina eye practices.
Separate from the coding information above. Vision Rescue Pro is a licensed ophthalmic distributor serving practices that image the retina every day.
- In-office Rx at wholesale, including dilation drops
- AREDS2 vitamins via RescueLink
- Price Match Guarantee
- Doctor Locator listing
Questions about CPT 92250
What is CPT code 92250?
It is the code for fundus photography, meaning photos of the retina and optic nerve, with the doctor's interpretation and report. It covers one or both eyes.
Is 92250 a bilateral code?
Yes. Medicare and most payers treat it as covering both eyes, so it is reported once without modifier 50. Some payers have their own rules for one-eye photos.
Can 92134 and 92250 be billed together?
Medicare treats them as generally mutually exclusive. Both are payable only when each is medically necessary for the same eye, with modifier 59 or XU on 92250 and a clear reason for each test in the record.
Can fundus photography and OCT be done on the same day?
They can be performed, but Medicare usually pays only one. Contractor LCDs say both are allowed when each is needed for the same eye and the record explains why.
Is fundus photography covered by Medicare?
Yes, when it documents or follows a condition, such as diabetic retinopathy or macular degeneration. Screening photos of a patient with no signs or symptoms are not covered.
Can 92250 be billed with extended ophthalmoscopy?
Generally not. Medicare's NCCI edits bundle extended ophthalmoscopy (92201, 92202) with fundus photography on the same day.
Sources
Medicare NCCI Policy Manual, Chapter 11, revised January 1, 2026; First Coast LCD L33751; Novitas LCD L35038; CGS LCD L34061; WPS LCD L34760; AAO list of First Coast retired LCDs; Retinal Physician column on extended ophthalmoscopy, 2020; Retina Specialist coding column on OCT and fundus photography; Review of Optometry coding column on retina codes; Optos billing FAQ on fundus photography, March 2026; Review of Ophthalmology Coding and Reimbursement 2026 Update.
Notes and disclosures
CPT is a registered trademark of the American Medical Association. Descriptions here are Vision Rescue summaries, not official CPT descriptors. This page is general information for eye care professionals and billing staff, not legal, billing or coding advice. Payer rules vary; verify codes, modifiers and coverage with the current official code sets, your Medicare contractor and the patient's plan. Questions: providers@visionrescue.com or 1-855-692-8024.
Photograph with a purpose.
In-office Rx, vitamins and patient follow-through for practices that image the retina.