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TO:  Physicians, Optometrists, Nurse Practitioners, Physician Assistants, Federally Qualified Health Centers, and Rural Health Clinics

RE:   New Coverage for Procedure Code 92229: Imaging of Retina for Disease Detection  

Effective for dates of service on or after October 1, 2023, Medicaid covers the following new procedure code:

Physicians, Optometrists, Nurse Practitioners, Physician Assistants, FQHC’s, and RHC’s may file CPT 92229 once annually for recipients ages 22 years old or older with diabetes (type1 or type2) not previously diagnosed with diabetic retinopathy. Once diabetic retinopathy is detected the patient should be under the direct care of an Ophthalmologist.

92229 should not be billed if the patient has had an in person ocular examination by an Ophthalmologist.

Please review Article - Billing and Coding: Remote Imaging of the Retina to Screen for Retinal Diseases (A58914) (cms.gov) for a full list of applicable ICD-10 diagnosis codes that support medical necessity for procedure code 92229.

Providers with billing questions may contact the Gainwell Technologies Provider Assistance Center at 1-800-688-7989. Providers with policy questions may contact Medicaid’s Physician Program at Physicians.Program@medicaid.alabama.gov.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2023 American Medical Association
and © 2023 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.