Date Issued: 5/3/2019
EmblemHealth has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards.
EmblemHealth has instituted additional payment policies for Fundus Photography.
According to the Centers for Medicare & Medicaid Services (CMS), the recommended frequency for Fundus Photography is no more than two times per 365 days except in unusual circumstances.
Fundus Photography involves the use of a specialized camera to photograph, through the dilated pupil, to produce a sharp view of the retina, the retinal vasculature, and the optic nerve head.
Fundus Photography may be used for the diagnosis of conditions such as macular degeneration, retinal neoplasm, choroid disturbances and diabetic retinopathy, glaucoma, multiple sclerosis, or other central nervous system anomalies.
Fundus Photography may be indicated to document abnormalities of disease processes affecting the eye, or to follow the progress of such disease.