Summary & Overview
CPT 2025F: Seven-Field Retinal Photography, No Diabetic Retinopathy
CPT code 2025F denotes seven-standard-field eye photography performed by an ophthalmology or optometry provider in a diabetic patient with documentation of no diabetic retinopathy. This code captures a diagnostic imaging service and professional interpretation used in diabetic eye disease surveillance and documentation. Nationally, consistent capture of this code supports quality measurement, care coordination, and monitoring of screening adherence for patients with diabetes. Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for seven-field retinal photography, the typical care setting, and why clear documentation matters for quality reporting. The publication summarizes common payer considerations, expected places of service, and how 2025F is used in clinical documentation workflows. It also highlights related billing and coding topics readers should review, such as quality measure reporting and imaging interpretation requirements. Data not available in the input is explicitly noted where relevant in supporting tables.
Billing Code Overview
CPT code 2025F documents that an ophthalmology or optometry provider performed seven-standard-field ocular photography in a patient with diabetes and found no evidence of diabetic retinopathy. The provider interprets the images and records the findings in the patient’s medical record.
Service Type: Diagnostic imaging and interpretation for diabetic eye disease surveillance
Typical Site of Service: Ophthalmology or optometry clinic
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with type 2 diabetes mellitus presents to an outpatient ophthalmology clinic for routine annual diabetic eye screening. The patient is asymptomatic with best-corrected visual acuity stable and no history of prior diabetic retinopathy. The ophthalmologist or optometrist performs mydriatic or non-mydriatic fundus photography capturing seven standard fields of each eye, interprets the images for signs of diabetic retinopathy, and documents normal findings in the chart. Imaging is performed in the clinic’s optical imaging suite or an ambulatory ophthalmology office. Typical workflow: patient intake and medication/allergy review, pupil dilation if required, seven-field fundus photography by trained tech or provider, image review and interpretation by the eye care provider, documentation of findings and screening outcome in the medical record, and communication of results to the patient and referring provider as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
ET | Eligible Telemedicine Modifier (site-specific or payer-defined) | Use when telemedicine or remote interpretation rules apply and payer requires ET for imaging-related telehealth services. |
25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure | Use if a separate E/M visit was provided on the same day in addition to the ocular photography and meets documentation requirements. |
26 | Professional Component | Use when billing only the professional interpretation/reading component separate from technical imaging. |
TC | Technical Component | Use when billing only the technical component for image acquisition. |
59 | Distinct Procedural Service | Use when a distinct and separate ophthalmic procedure unrelated to the screening photography is performed the same day. |
52 | Reduced Services | Use when the imaging service was partially reduced or not fully performed and reduction must be reported. |
53 | Discontinued Procedure | Use when the photography was started but discontinued for documented clinical reasons. |
EP | Service Provided in an Emergency Department | Use when the fundus photography is performed in an ED setting and payer requires ED-specific modifier. |
AO | Worker’s Compensation, an on-the-job injury | Use when the service is related to an occupational injury covered under worker’s compensation. |
GA | Waiver of Liability Statement on File (ABN) | Use when a provider has an Advance Beneficiary Notice for non-covered or non-reimbursable services. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207W00000X | Ophthalmology | Ophthalmologists commonly perform and interpret seven-field diabetic retinal photography. |
| 174400000X | Optometry | Optometrists perform imaging and interpret findings in ambulatory settings where permitted. |
| 207Y00000X | Retina Specialist (Ophthalmology) | Retinal specialists interpret complex imaging and confirm findings when subtle retinopathy is suspected. |
| 3336C0003X | Ophthalmic Photography Technician | Trained imaging technicians often acquire the seven standard fields under provider supervision. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
92250 | Fundus photography with interpretation and report | Often used alternatively or in addition for digital fundus photography services and may be billed when broader photography is performed. |
92227 | Remote imaging for detection of retinal disease (single image), treated as screening | Used for tele-ophthalmology diabetic retinal screening programs; may precede or substitute seven-field imaging depending on program protocols. |
92228 | Remote imaging for detection of retinal disease, with remote interpretation and report | Used when images are obtained and interpreted remotely; related to workflows where interpretation is billed separately. |
67028 | Intravitreal injection of a pharmacologic agent | May follow if imaging detects diabetic macular edema requiring treatment; represents a subsequent interventional service. |
99213 | Office or other outpatient visit, established patient, low-moderate complexity | Commonly performed on the same day for diabetes management or ocular complaints; use of modifier 25 may be required if billed with imaging. |