Summary & Overview
CPT 92229: Point-of-Care Retinal Imaging with Autonomous Analysis
CPT code 92229 covers point-of-care retinal imaging for one or both eyes that uses autonomous (machine) analysis and includes the reporting of findings. The code represents a growing class of diagnostic services that apply artificial intelligence at the point of care to detect and monitor retinal disease, and it has implications for clinical workflow, access to diagnostic screening, and payer coverage policies nationwide. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, payer coverage considerations, common modifiers, and clinical context for use. The publication also summarizes typical sites of service, the service type, and outlines what benchmarks and policy updates are relevant for stakeholders involved in ophthalmology, optometry, primary care, and ambulatory diagnostics. Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, related codes, and detailed payer policy language is noted where applicable.
Billing Code Overview
CPT code 92229 describes point-of-care retinal imaging of one or both eyes that uses autonomous (machine) analysis to assist in diagnosing and monitoring retinal disease. This service includes reporting of the autonomous interpretation and is delivered at the point of care.
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Service type: Point-of-care diagnostic retinal imaging with autonomous (machine) analysis and report
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Typical site of service: Office or clinic point-of-care setting where retinal imaging devices with autonomous analysis are used
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient with type 2 diabetes attends a primary eye care clinic for routine diabetic retinopathy screening. The clinic uses a point-of-care autonomous retinal imaging system to capture fundus photographs of one or both eyes. The device acquires images, performs machine-based analysis, and generates an automated report indicating whether signs of diabetic retinopathy or macular edema are present. The patient’s images and autonomous report are reviewed by the treating clinician during the same visit to determine need for further evaluation, referral to a retina specialist, or routine follow-up. Typical workflow steps include patient registration, acquisition of retinal images at a point-of-care location (clinic or ambulatory surgical center), automated analysis and report generation, clinician review, documentation in the medical record, and coding/billing for the autonomous imaging service using 92229 for each eye as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the interpreting/reading professional component separate from technical acquisition (rare for 92229 which includes reporting) |