Fundus photos are not covered by Medicare and commercial insurance carriers unless ordered to document pathology such as diabetic retinopathy, age-related macular degeneration, choroidal nevi, or vein or artery occlusion. Does a screening fundus photo in a Medicare patient require the patient to sign an Advance Beneficiary Notice that the study may not be covered by Medicare, so the patient is responsible for the charges?
An Advance Beneficiary Notice is required when Medicare reimbursement is unknown for a potentially covered service. However, according to feedback from the coding divisions
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