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TO:  Physicians, Optometrists, Nurse Practitioners, Physician Assistants, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)

RE:   New Coverage for procedure code 92229: Imaging of retina for disease detection 

Effective for dates of service on or after October 1, 2023, Medicaid covers the following new procedure code:

Physicians, Optometrists, Nurse Practitioners, Physician Assistants, FQHC’s and RHC’s may file CPT 92229 once annually for recipients ages 22 years old or older with diabetes (Type 1 or Type 2) not previously diagnosed with diabetic retinopathy. Once diabetic retinopathy is detected, the patient should be under the direct care of a qualified eye care professional.

Please review Article - Billing and Coding: Remote Imaging of the Retina to Screen for Retinal Diseases (A58914) (cms.gov) for a full list of applicable ICD-10 diagnosis codes that support medical necessity for procedure code 92229.

Providers with billing questions may contact the Gainwell Technologies Provider Assistance Center at 1-800-688-7989. Providers with policy questions may contact Medicaid’s Physician Program at Physicians.Program@medicaid.alabama.gov.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2025 American Medical Association and © 2025 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.