About this policy
LCD Information
Document Information
Source LCD ID
N/A
LCD ID
L34393
Original ICD-9 LCD ID
Not Applicable
LCD Title
Ocular Photography - External
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 05/01/2025
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A
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Issue
Issue Description
Annual review performed no changes were made.
Issue - Explanation of Change Between Proposed LCD and Final LCD
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:Title XVIII of the Social Security Act (SSA): Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Code of Federal Regulations: 42 CFR Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).
Coverage Indications, Limitations, and/or Medical Necessity
Abstract:External ocular photography is a non-invasive procedure used to photo-document conditions of the external structures of the eye (e.g., eyelids, lashes, sclera, conjunctiva and cornea). External photography techniques may also be used to document conditions related to structures of the anterior segment of the eye. These would include the anterior chamber, iris, crystalline lens and filtration angle. External ocular photography is accomplished by using a slit-lamp-integrated camera, photography through a goniophotography lens or with a close-up stereo camera. Photographs may be prints, slides, videotapes or digitally stored. Indications:This procedure may be indicated when photo-documentation is required to track the progression or lack of progression of an eye condition, or to document the progression of a particular course of treatment. External ocular photography is covered when a special camera is used to obtain magnified photographs of lesions (e.g., the cornea, iris or lids) for the purpose of following the patient’s condition. Medical quality images may be digital, Polaroid Macro 3 SLF or equivalent. Limitations:While many conditions of the eye could be photographed, this procedure should not be used to simply document the existence of a condition in order to enhance the medical record. Photographs for the purpose of documentation for medical legal purposes or preauthorization (e.g., gross trauma, amount of ptosis or redundant lid tissue for blepharoplasty) are not separately reportable or reimbursable.Photography may be reported only once per session, even though multiple views may be taken. In addition to the photograph(s), an interpretation and report specific to the photograph(s) must be contained in the patient's medical record and be available to the contractor upon request. External ocular photography without accompanying patient identification and date permanently affixed to the photograph will be considered not to be reasonable or necessary and will be denied.
Summary of Evidence
N/A
Analysis of Evidence (Rationale for Determination)
N/A
Coverage indications
Abstract: External ocular photography is a non-invasive procedure used to photo-document conditions of the external structures of the eye (e.g., eyelids, lashes, sclera, conjunctiva and cornea). External photography techniques may also be used to document conditions related to structures of the anterior segment of the eye. These would include the anterior chamber, iris, crystalline lens and filtration angle. External ocular photography is accomplished by using a slit-lamp-integrated camera, photography through a goniophotography lens or with a close-up stereo camera. Photographs may be prints, slides, videotapes or digitally stored. Indications: This procedure may be indicated when photo-documentation is required to track the progression or lack of progression of an eye condition, or to document the progression of a particular course of treatment. External ocular photography is covered when a special camera is used to obtain magnified photographs of lesions (e.g., the cornea, iris or lids) for the purpose of following the patient’s condition. Medical quality images may be digital, Polaroid Macro 3 SLF or equivalent. Limitations: While many conditions of the eye could be photographed, this procedure should not be used to simply document the existence of a condition in order to enhance the medical record. Photographs for the purpose of documentation for medical legal purposes or preauthorization (e.g., gross trauma, amount of ptosis or redundant lid tissue for blepharoplasty) are not separately reportable or reimbursable. Photography may be reported only once per session, even though multiple views may be taken. In addition to the photograph(s), an interpretation and report specific to the photograph(s) must be contained in the patient's medical record and be available to the contractor upon request. External ocular photography without accompanying patient identification and date permanently affixed to the photograph will be considered not to be reasonable or necessary and will be denied.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.