Retinal Telescreening for Diabetic Retinopathy
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Defines coverage and coding for retinal telescreening using digital imaging (including AI-based interpretation) for detection, monitoring, and management of diabetic retinopathy for BCBSRI Medicare Advantage and commercial members.
No material clinical or coverage changes in this revision.
Coverage Criteria for Retinal Telescreening
Coverage criteria
Covered when ALL of the following are met:
ALL of the following
Applicable products
- Member is enrolled in a BCBSRI Medicare Advantage plan or a BCBSRI commercial product
Indication
- Screening for detection of diabetic retinopathy
- Monitoring or management of known diabetic retinopathy
Image acquisition and interpretation method
- Digital retinal imaging with manual grading/interpretation performed by a primary care provider, optometrist, or ophthalmologist (images obtained and remotely reviewed)
- Digital retinal imaging with image interpretation by FDA‑cleared AI software (eg, IDX‑DR, EyeArt)
- Benefits and coverage are subject to the member's group/contract terms; refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement
See plan specific benefit limitations or exclusions
Coding and reimbursement notes
- CPT 92227 is covered and not separately reimbursed for both professional and institutional providers when remote clinical staff review and report is used
- CPT 92228 is covered and separately reimbursed when filed by a PCP, optometrist, or ophthalmologist (remote physician or other qualified health care professional interpretation and report)
- CPT 92229 is covered for point‑of‑care autonomous analysis and report
Coding and Billing Rules
| 92227 | Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral |
| 92228 | Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care professional interpretation and report, unilateral or bilateral |
| 92229 | Imaging of retina for detection or monitoring of disease; point-of-care autonomous analysis and report, unilateral or bilateral |
Provider Actions and Requirements
Prior authorization not required
No prior authorization is required for retinal telescreening.
Definitions
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