Trends in Remote Retinal Imaging Utilization and Payments in the United States

Abstract

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Teleophthalmology provides earlier eye care access for patients with newly-diagnosed diabetes

“…The primary outcome measure was time to eye exam within 1 year as indicated by remote retinal imaging or an in-person visit to an eye care provider. A claim was classified as remote screening if it included Current Procedural Terminology (CPT) codes for remote retinal imaging (92227 or 92228) by any provider, or for fundus photography (92250) billed by a non-eyecare provider, as previously described [ 15 ]. Otherwise, a claim was considered an in-person eyecare visit if the physician specialty was “ophthalmologist” or “optometrist,” and did not fall under the definition of remote screening.…”

“…At a large integrated health system in Northern California, Ellis et al found that 55% of charges for remote DR screening using telehealth codes were denied by non-capitated insurance plans, and 40% were denied by private insurers [ 14 ]. Despite the rapid increase in teleophthalmology utilization across the U.S., insurance coverage has declined according to national insurance claims data, with disproportionate impact on vulnerable populations such as older, Black, and lower-income patients [ 15 ]. Building evidence to support the clinical benefit of remote DR screening may help encourage insurance payers to expand coverage for teleophthalmology services.…”

Advances in Teleophthalmology Screening for Diabetic Retinopathy

“…102 The proportion of claims paid for by Medicare Advantage was substantially lower than those paid for by other commercial payers. 102 Clinicians and health care administrators have cited low reimbursement as a barrier to the sustainability of teleophthalmology programs. 32 Patients also reported high out-of-pocket costs as a barrier to the use of teleophthalmology.…”

“…A US study using a national claims database found a 34.6% decline in the proportion of claims paid for remote retinal imaging from 2011 to 2020 102 . The proportion of claims paid for by Medicare Advantage was substantially lower than those paid for by other commercial payers 102 .…”

“…A US study using a national claims database found a 34.6% decline in the proportion of claims paid for remote retinal imaging from 2011 to 2020 102 . The proportion of claims paid for by Medicare Advantage was substantially lower than those paid for by other commercial payers 102 . Clinicians and health care administrators have cited low reimbursement as a barrier to the sustainability of teleophthalmology programs 32 .…”