CurrentCentenePolicy CP.VP.43

External Ocular Photography

Medical necessity criteria and coding guidance for use of external ocular photography to document and track external eye, eyelid, and anterior segment conditions for members of Centene-affiliated health plans.

Policy Summary

PayerCentene

PolicyExternal Ocular Photography

Policy CodePolicy CP.VP.43

Change TypeNo material changes

Effective Date

Next Review DateAug 1, 2025

Key ActionUse CPT 92285 with interpretation and report and document the specific ICD-10 diagnosis from the provided list to justify external ocular photography.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

92285Procedure code referenced

20+Diagnosis codes (partial shown)

MixedPolicy stance

Centene/EnvolvePayer scope

Coverage Criteria for External Ocular Photography

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Indications list: A. Keratitis, corneal degeneration, dystrophy, injury, edema, ulceration, opacification, ectasia or perforation; B. Iridocyclitis and associated glaucoma; C. Anterior chamber inflammation, hyphema, narrow angle, or synechiae; D. Conjunctivitis, episcleritis, scleritis; E. Eyelid pathology, including blepharitis, dermatitis, entropion, ectropion, ptosis, retraction, xanthelasma, chloasma, madarosis, edema and vascular abnormalities; F. External ocular and eyelid pathology including neoplasms, melanomas, carcinomas, cysts, trauma and burns.

Each listed condition qualifies when photography is used to track progression.

Not Medically Necessary

External ocular photography is not medically necessary in the following situations:

Not medically necessary scenarios: A. Routine use of external ocular photography to document the appearance of healthy anatomy; B. Duplicative documentation of retinal pathology with anterior segment scanning computerized ophthalmic diagnostic imaging unless the additional diagnostic procedure provides new information to assist in clinical decision-making; C. Repeated performance in the presence of controlled and/or stable disease.

These situations may be denied as not medically necessary.

Diagnosis-linked coverage

External ocular photography is associated with the following diagnoses (partial list):

Diagnosis list: External ocular photography may be used for patients with any of the listed ICD-10 diagnoses in this section (examples include corneal pigmentations, Kayser-Fleischer ring, stromal corneal pigmentations, and multiple corrosion/burn injury codes) to document external ocular/periocular pathology.

Provider must select the appropriate ICD-10 code from the list when submitting claims.

External ocular photography is not medically necessary when used for routine documentation of healthy anatomy, because the policy specifies that routine imaging of normal-appearing external ocular structures does not meet medical necessity. The policy also identifies duplicative imaging of retinal pathology with anterior segment scanning computerized ophthalmic diagnostic imaging as not medically necessary unless the photography provides new information to assist clinical decision-making. Finally, repeated imaging performed while disease is controlled or stable may be considered unnecessary and subject to denial.

Coding — CPT and ICD-10 Guidance

Covered CPT CodesCPTCovered

92285

External ocular photography with interpretation and report for documentation of medical progress

ICD-10 Diagnosis Codes that Support Coverage (partial list)ICD-10

A18.51	Tuberculous episcleritis
A18.52	Tuberculous keratitis
A18.54	Tuberculous iridocyclitis
A50.31	Late congenital syphilitic interstitial keratitis
B00.51	Herpes viral iridocyclitis
B00.52	Herpes viral keratitis
B00.53	Herpes viral conjunctivitis
B02.31	Zoster conjunctivitis
B02.32	Zoster iridocyclitis
B02.33	Zoster keratitis

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ICD-10-CM codes relevant to External Ocular Photography (excerpt)ICD-10

H04.131	Lacrimal cyst, right lacrimal gland
H04.132	Lacrimal cyst, left lacrimal gland
H04.161	Lacrimal gland dislocation, right lacrimal gland
H04.162	Lacrimal gland dislocation, left lacrimal gland
H04.163	Lacrimal gland dislocation, bilateral lacrimal glands
H04.311	Phlegmonous dacryocystitis of right lacrimal passage
H04.312	Phlegmonous dacryocystitis of left lacrimal passage
H04.313	Phlegmonous dacryocystitis of bilateral lacrimal passages
H04.321	Acute dacryocystitis of right lacrimal passage
H04.322	Acute dacryocystitis of left lacrimal passage

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Listed ICD-10 Codes (external ocular photography justifications)ICD-10

H05.011	Cellulitis of right orbit
H05.012	Cellulitis of left orbit
H05.013	Cellulitis of bilateral orbits
H05.021	Osteomyelitis of right orbit
H05.022	Osteomyelitis of left orbit
H05.023	Osteomyelitis of bilateral orbits
H05.031	Periostitis of right orbit
H05.032	Periostitis of left orbit
H05.033	Periostitis of bilateral orbits
H05.041	Tenonitis of right orbit

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Additional ICD-10-CM codes listed (excerpt)ICD-10

H05.51	Retained (old) foreign body following penetrating wound of right orbit
H05.52	Retained (old) foreign body following penetrating wound of left orbit
H05.53	Retained (old) foreign body following penetrating wound of bilateral orbits
H05.811	Cyst of right orbit
H05.812	Cyst of left orbit
H05.813	Cyst of bilateral orbits
H05.821	Myopathy of extraocular muscles, right orbit
H05.822	Myopathy of extraocular muscles, left orbit
H05.823	Myopathy of extraocular muscles, bilateral orbits
H05.831	Thyroid orbitopathy, right orbit

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ICD-10-CM codes (additional excerpt)ICD-10

H10.221	Pseudomembranous conjunctivitis, right eye
H10.222	Pseudomembranous conjunctivitis, left eye
H10.223	Pseudomembranous conjunctivitis, bilateral
H10.231	Serous conjunctivitis, except viral, right eye
H10.232	Serous conjunctivitis, left eye
H10.233	Serous conjunctivitis, bilateral
H10.411	Chronic giant papillary conjunctivitis, right eye
H10.412	Chronic giant papillary conjunctivitis, left eye
H10.413	Chronic giant papillary conjunctivitis, bilateral
H10.421	Simple chronic conjunctivitis, right eye

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Provider Actions, Billing and Documentation

Billing Rule

Billing and CPT Coding

Use CPT 92285 when billing for external ocular photography that includes interpretation and a report (e.g., close-up, slit-lamp, goniophotography, stereo-photography).

Required billing CPT: 92285 — External ocular photography with interpretation and report.

Prior Authorization

Prior Authorization Not Specified

Prior authorization (PA) requirements are not specified in the excerpted policy text. Providers should check the member's Health Plan for any plan-specific PA rules before submitting claims.

No PA instruction present in this policy excerpt — confirm with the member's plan.
Verify PA requirements with the Health Plan prior to scheduling or billing.

Prior Authorization

Prior Authorization Absence for ICD-10 Listings

This policy segment lists ICD-10 codes that support medical necessity but does not include explicit prior authorization instructions for those codes; documentation and coding should be used to demonstrate necessity.

ICD-10 code lists are provided in the policy excerpts (H02–H18, H40, H44 series) but PA guidance is absent here.

Prior Authorization

Verify Effective Date and Plan PA Processes

Confirm the effective date and any Health Plan-specific PA processes before relying on this clinical policy for coverage decisions. The policy states the effective date is determined by the Health Plan and posting may not reflect the plan effective date.

Verify Health Plan effective date and any plan-level PA requirements prior to treatment or claim submission.

Documentation Required

Diagnosis Coding Supports Medical Necessity

Document clinical indications using appropriate ICD-10-CM diagnosis codes from the H02–H18, H40, H44 series as applicable to support medical necessity for external ocular photography.

Document a specific ICD-10 diagnosis code in the record to justify the service (examples appear in policy: H02.*, H18.*, H40.*, H44.*).
Claims should include an ICD-10 diagnosis that links to the medical necessity criteria; lack of appropriate coding may risk denial.

Denial Risk

Denial Risk Related to Coverage Documents

Coverage decisions are subject to the member's coverage documents, including exclusions, limitations and state Medicaid provisions where applicable. Failure to follow plan terms may result in denial.

Coverage is governed by the Health Plan's evidence of coverage, certificate, policy or contract — check those documents for exclusions/limitations.
State Medicaid provisions override this policy where applicable.

Documentation Required

Documentation Expectations

Clinical documentation must include the photographic views and procedural components performed (e.g., close-up photography, slit-lamp photography, goniophotography, stereo-photography), clinical indication, date of service, interpreter's report, and correlation to the ICD-10 diagnosis. Maintain records to support the medical necessity and billing of the service.

Required photographic views: close-up, slit-lamp, goniophotography, stereo as applicable.
Include interpretation and a written report with clinical findings and how images support management.
Keep complete records to support claims and potential audits.

Documentation Required

Provider Responsibilities and Recordkeeping

Providers are responsible for exercising professional judgment, submitting accurate claims with appropriate CPT and ICD-10 linkage, and retaining documentation that supports medical necessity. The policy does not replace provider judgment or plan contract terms.

Providers must submit claims with CPT 92285 when appropriate and include the supporting ICD-10 diagnosis code.
Providers are expected to keep full medical records and the interpretation/report used to support billing.
This policy is a guide — providers retain responsibility for clinical decisions and claim accuracy.

Definitions

inv-29: External ocular photography — definition and typical modalities

DefinitionExternal ocular photography: close-up imaging of external eye and anterior segment structures using a hand-held camera, slit-lamp–integrated camera, goniophotography lens, or close‑up stereo camera; output may be prints, slides, videotapes or digital images.

Typical modalitiesClose-up (hand-held) photography — still or video capture of lids, lashes, conjunctiva and cornea.

Slit‑lamp integratedSlit‑lamp–mounted photography for magnified anterior segment imaging (cornea, iris, anterior chamber).

GoniophotographyImaging through a goniophotography lens to document the filtration angle and angle‑related pathology.

Stereo photographyClose‑up stereo cameras for three‑dimensional documentation of periocular and anterior segment anatomy and lesions.

inv-30: External Ocular Photography diagnosis list — reference to comprehensive ICD-10-CM list (H02–H18 series excerpts)

Scope of diagnosis listComprehensive ICD‑10‑CM listings drawn from H02–H18 series covering eyelid, lacrimal, conjunctival, scleral and corneal conditions.

Eyelid and periocular examplesChloasma (H02.715); Madarosis (H02.721–H02.725); Vitiligo of eyelid (H02.731–H02.735); retained foreign body and cysts (H02.811–H02.825).

Lacrimal and orbital examplesAcute/chronic dacryoadenitis and lacrimal cysts (H04.011–H04.133); orbital inflammation and deformity (H05.x series).

Corneal and anterior segment examplesAnterior corneal pigmentations, corneal deposits, Kayser‑Fleischer ring and stromal pigmentations (H18.011–H18.063).

inv-31: External ocular photography — short definition tying imaging to ICD-10 diagnoses

Short definitionDiagnostic imaging of external ocular and periocular structures (eyelids, conjunctiva, sclera, cornea, anterior chamber, iris, lens, filtration angle) used to document and track pathology tied to specific ICD‑10 diagnoses.

PurposeDocument progression, response to therapy, or surgical/trauma healing for external ocular conditions.

Image storageImages may be stored as prints, slides, videotapes or digital media and used in the medical record to support diagnoses and claims.

inv-32: ICD-10-CM codes listed — examples (burns, corrosions, corneal transplant complications) enumerated to justify photography

Burns and sequelaeT26.11XA/T26.11XD/T26.11XS; T26.12XA/T26.12XD/T26.12XS — burns of cornea/conjunctival sac and related encounters.

Eyelid/periocular burns and corrosionsT26.02XS; T26.51XA/T26.51XD/T26.51XS; T26.52XA/T26.52XD/T26.52XS — burns/corrosions of eyelid and periocular area.

Corrosion of cornea/conjunctival sacT26.61XA/T26.61XD/T26.61XS; T26.62XA/T26.62XD/T26.62XS — corrosion injuries to cornea and conjunctival sac.

Corrosion with globe ruptureT26.71XA/T26.71XD/T26.71XS; T26.72XA/T26.72XD/T26.72XS — corrosion with rupture/destruction of the eyeball.

Corneal transplant complicationsT86.8401–T86.8403 (rejection), T86.8411–T86.8413 (failure), T86.8421–T86.8423 (infection), T86.8481–T86.8483 (other complications).

OpenPayer

External Ocular Photography

Coverage Criteria for External Ocular Photography

Coding — CPT and ICD-10 Guidance

Provider Actions, Billing and Documentation

Background

Definitions

Revision History