CPT code 92227 – Retinal imaging with remote staff review

Key takeaways

CPT code 92227 is a complete service: retinal imaging with remote clinical staff review and report, unilateral or bilateral, billed as one unit per patient.

Medicare assigns 92227 PC/TC indicator 3, which makes it a technical-only code, so modifiers -26 and -TC cannot be appended to it.

Codes 92227, 92228 and 92229 are alternatives, chosen by who reviews the images: clinical staff, a physician or other QHP, or autonomous AI software.

The 2026 national Medicare rate for 92227 is $18.70, and the facility and non-facility amounts are identical.

Pabau, the practice management platform we build, checks eligibility through Claim.MD and validates every claim before it reaches the payer.

What CPT code 92227 covers

CPT code 92227 reports imaging of the retina for detection or monitoring of disease, with remote clinical staff review and report. It covers one or both eyes as a single service. Image capture, the staff review, and the written report all sit inside the one code.

The American Medical Association (AMA) revised the descriptors for 92227 and 92228 in the 2021 code set. The change named who reviews the images, which is now what separates the codes.

Three features define a 92227 service:

• Remote review: Trained clinical staff review the images at a site away from where they were captured. The images travel electronically from the capture site to the reviewer.
• A complete service: Capture, staff review and the report are one billable unit. No separate interpretation code is added to it, and it is never split into components.
• Screening population: Medicare contractors tie coverage to diabetes, usually as screening for diabetic retinopathy before any retinopathy is found. Commercial payers set their own indications.

Wide-field and non-mydriatic cameras make this workflow practical in primary care and endocrinology settings. Noridian requires the device to be FDA approved for the intended use, and the person capturing images must be fully trained on it.

CPT 92227 vs 92228 vs 92229: Staff review, physician review or autonomous AI

CPT 92227, 92228 and 92229 are three alternative ways to report the same kind of imaging, and the reviewer decides which one applies. Clinical staff review is 92227, and a physician or other qualified health care professional (QHP) is 92228. AI software at the point of care is 92229. Each is a standalone service, so a claim reports one of them for the imaging session.

92228 is the only code in the family that carries a professional/technical split. A reading physician can bill 92228-26 for the interpretation, and the capture site can bill 92228-TC. That split belongs to 92228 alone and never pairs with a 92227 claim. 92228 does not require a 92227 claim, and omitting it never causes a 92227 denial.

Noridian adds a clinical rule of thumb. Once diabetic retinopathy is diagnosed, 92227 no longer applies because the care is no longer screening. Follow-up remote imaging for that patient moves to 92228, or to 92229 when no ophthalmologist is available. The diagram below puts the whole choice on one screen.

CPT 92227 vs 92250: Choosing the right retinal imaging code

CPT 92250 is fundus photography with interpretation and report, performed as part of an in-person eye care service. It is not a remote review code. CPT 92227 is the right code when trained staff review the images away from the capture site.

Billing 92250 for a teleretinal screening program misreports the service. The American Academy of Ophthalmology has advised against reporting 92250-26 for telemedicine reads under Medicare Part B. The remote imaging family exists for that work.

Clinical indications and ICD-10-CM codes for CPT 92227

Medical necessity for CPT 92227 rests on a confirmed diabetes diagnosis documented in the patient chart. Payers will not approve the claim for a family history of diabetes or a risk of diabetes alone. For a patient with type 2 diabetes and no complications, the supporting code is usually E11.9.

All five codes appear on the covered diagnosis list in Noridian billing article A58914. Other MACs publish their own lists, so check the article for your jurisdiction. Codes such as E11.65 (hyperglycemia) or E11.36 (diabetic cataract) are missing from the Noridian list, so do not lean on them for coverage.

How the procedure is performed and documented

The 92227 workflow follows the same sequence whichever camera you use. Each step leaves a record that supports the claim.

1. Patient consent: Obtain and document consent for the retinal imaging and for electronic transmission of the images.
2. Image capture: Capture fundus images with an FDA-approved retinal camera. Record the device and whether one eye or both were imaged.
3. Quality check: Confirm the images are gradable. Ungradable images cannot support a report, so record the reason and the plan to re-image.
4. Secure transmission: Send images through a HIPAA-compliant image transmission platform and keep the transmission record.
5. Remote staff review and report: Trained clinical staff review the images and issue the written report. That report is part of the 92227 service.
6. Record storage: Archive the images, the report and the transmission record in the EHR, where an auditor can reach them.

If a physician or other QHP writes the interpretation instead of clinical staff, the service is 92228, not 92227. Match the code to the person who signed the report.

Medicare coverage rules for CPT 92227

Medicare coverage for CPT 92227 is set by each Medicare Administrative Contractor (MAC), not by a single national benefit. The billing article that applies depends on the MAC jurisdiction where the service was rendered. Read the medical claims clearinghouse guide for submission steps, and confirm the active article with your MAC before billing.

Noridian billing article A58914 is a useful example of the parameters MACs set:

• Eligible patients: Type 1 diabetes for more than five years, or Type 2 diabetes from the time of diagnosis.
• Purpose: Early detection of diabetic retinopathy, every year until retinopathy is detected.
• Frequency: Noridian will not pay 92227 more often than once a year, and one unit covers both eyes.
• Recent eye exam: Do not bill 92227 or 92229 when the patient has had an in-person ocular exam by an ophthalmologist.
• Device and staff: The camera must be FDA approved for the use, and the capturing site must show the operator is fully trained.

Other MACs word these limits differently, and commercial payers set their own rules. Check the frequency and exclusion language for each payer before you schedule screening.

2025 and 2026 reimbursement rates for CPT 92227

The 2026 national Medicare payment for CPT 92227 is $18.70, before geographic adjustment. That figure is 0.56 total RVUs multiplied by the 2026 conversion factor of $33.4009, taken from the CMS Physician Fee Schedule relative value file. Because 92227 carries no work RVU and identical practice expense RVUs in both settings, the facility and non-facility rates match.

The 2026 rate uses the conversion factor for clinicians who are not qualifying APM participants. Qualifying APM participants use $33.5675, which puts 92227 at about $18.80. Geographic Practice Cost Indices (GPCIs) then adjust each figure for your Medicare locality.

Use the FastRVU reimbursement lookup to see the locality-adjusted payment for 92227 in your MAC jurisdiction. When you model a teleretinal program, price each patient at one code: 92227, 92228 or 92229, depending on who reviews the images.

Modifiers and place of service codes for CPT 92227

Most 92227 claims need no modifier at all. The modifiers coders reach for by habit are either invalid on this code or apply only in narrow cases.

Report the place of service where the images are captured, which is usually POS 11 for a physician office. Check your MAC guidance before using POS 02 or a telehealth modifier, because the code descriptor already describes remote review.

Prior authorization for CPT 92227

Medicare generally does not require prior authorization for CPT 92227. The claim must still meet the MAC article criteria to survive a post-payment review.

Several commercial and managed care plans do require prior authorization for remote retinal imaging, and the rules can change between plan years. Verify the requirement with each payer before you launch a teleretinal screening program. Collect the following for any request:

• The patient’s current diabetes diagnosis (ICD-10-CM code)
• The date of the last dilated eye exam, if there was one
• The clinical reason for remote imaging rather than an in-person exam
• The reviewing service or staff, and the billing provider’s NPI
• The device or platform used for capture and transmission

Record the authorization number in the patient chart and on the claim. A missing number on a commercial claim is a common denial that cannot be fixed after the fact.

Common denial reasons for CPT 92227 claims

Most 92227 denials trace back to a coverage criterion or a coding choice that does not match the service. A denial management workflow for this code set prevents rework and protects revenue.

Reviewing the denial codes on your 92227 remittances shows whether denials cluster around one cause. One dominant cause points to a workflow fix. A spread of causes points to a training need.

Documentation checklist for CPT 92227 claims

Every 92227 claim should be backed by a complete record before it goes out. Submitting a clean claim means the chart holds all of the following:

• A confirmed diabetes ICD-10-CM code documented in the encounter note
• The date of capture and the name of the staff member who captured the images
• The imaging device used, where the MAC article requires it
• A gradability note, or the reason the images could not be graded
• Which eye or eyes were imaged
• The transmission record with timestamp, destination and delivery confirmation
• The signed staff review and report, with the reviewer’s name and credentials
• Patient consent for imaging and electronic transmission
• Confirmation that no excluded in-person eye exam took place
• The prior authorization number, where a commercial payer requires one

If an auditor finds any one item missing, a paid claim can turn into a recoupment demand. A pre-submission checklist in the EHR stops that before the claim drops.

How to bill CPT 92227 in a Rural Health Clinic

Rural Health Clinics (RHCs) are paid an all-inclusive rate (AIR) for qualifying visits, not through the Medicare Physician Fee Schedule. The AIR covers the professional services of RHC practitioners. The technical components of diagnostic tests sit outside it and are billed to Part B separately.

That matters for 92227, because Medicare classes the entire code as technical. Three billing routes follow from it:

• Freestanding RHC: Bill 92227 to the MAC on a professional claim under the practitioner’s Part B identifier, outside the RHC encounter.
• Provider-based RHC: Bill the technical service under the parent provider’s identifier rather than on the RHC claim.
• Outside reading service: A contracted service that performs the review bills under its own NPI. The arrangement must follow CMS reassignment rules.

Confirm the route with your MAC before you build it into the workflow. A 92227 line left on the RHC encounter claim is easy to lose without anyone noticing.

How Pabau keeps 92227 claims accurate and paid

A teleretinal program spreads one claim across several hands. Staff capture the images, a reviewer writes the report, and the billing team later picks the code. If the person who signed the report is unclear, the claim lands on the wrong code in the 92227 family.

In Pabau, the diagnosis, consent and imaging notes live in the patient record that the invoice draws on. Pabau’s claims management software validates each claim for missing or invalid details before it leaves the practice. Claims go out as electronic CMS-1500s through Pabau’s Claim.MD integration, with eligibility checked before the visit.

Remittances come back as ERA files, so a 92227 denial surfaces in days. You can correct the code or the diagnosis while the screening is still fresh.

Manage ophthalmic billing without the complexity

Pabau supports CPT coding workflows for eye care and primary care practices. Build claim templates, verify eligibility before the encounter, and submit through Claim.MD’s clearinghouse with built-in CPT and ICD-10 catalogs.

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Conclusion

CPT 92227 is the code for remote retinal screening reviewed by clinical staff, and it stands on its own. Bill it as one technical-only unit, with no -26 or -TC and no 92228 alongside it. When a physician reads the images, or retinopathy is already diagnosed, switch to 92228 or 92229 rather than adding a second code.

Practices that code to the person who signed the report avoid most of the denials this code attracts. Book a demo to see how Pabau keeps diagnosis, documentation and claim in one record for your retinal screening program.

Continue your research

Need to understand how clearinghouse submission works for specialty codes? Our Claim.MD clearinghouse guide explains the end-to-end electronic claims process for US practices.

Seeing recurring claim rejections across your practice? Revenue cycle management fundamentals covers the workflow shifts that reduce systematic denial rates.

Need to read the remittance behind a 92227 denial? Electronic remittance advice (ERA) explained walks through how to read 835 remittance files and act on CARC denial codes.

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