Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 15102 | CGS Administrators, LLC | MAC - Part B | KY |
| 15202 | CGS Administrators, LLC | MAC - Part B | OH |
| 15101 | CGS Administrators, LLC | MAC - Part A | KY |
| 15201 | CGS Administrators, LLC | MAC - Part A | OH |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57068 (Billing and Coding: Ocular Photography - External) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57068: Billing and Coding: Ocular Photography - External (Billing and Coding, effective 2026-09-03)
- Covered ICD-10-CM codes
- 1056
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 1
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| A18.51 | — |
| A18.52 | — |
| A18.54 | — |
| A18.59 | — |
| A50.31 | — |
| B00.50 | — |
| B00.51 | — |
| B00.52 | — |
| B00.53 | — |
| B00.59 | — |
| B02.31 | — |
| B02.32 | — |
| B02.33 | — |
| B02.34 | — |
| B02.39 | — |
| B10.81 | — |
| B10.82 | — |
| B10.89 | — |
| B30.0 | — |
| B60.12 | — |
| B60.13 | — |
| C43.111 | — |
| C43.112 | — |
| C43.121 | — |
Procedure codes: 92285.
Coverage indications, limitations and medical necessity
Abstract:
External ocular photography is a non-invasive procedure used to photo-document conditions of the external structures of the eye (e.g., eyelids, lashes, sclera, conjunctiva and cornea). External photography techniques may also be used to document conditions related to structures of the anterior segment of the eye. These would include the anterior chamber, iris, crystalline lens and filtration angle. External ocular photography is accomplished by using a slit-lamp-integrated camera, photography through a goniophotography lens or with a close-up stereo camera. Photographs may be prints, slides, videotapes or digitally stored.
Indications:
This procedure may be indicated when photo-documentation is required to track the progression or lack of progression of an eye condition, or to document the progression of a particular course of treatment.
External ocular photography is covered when a special camera is used to obtain magnified photographs of lesions (e.g., the cornea, iris or lids) for the purpose of following the patient’s condition. Medical quality images may be digital, Polaroid Macro 3 SLF or equivalent.
Limitations:
While many conditions of the eye could be photographed, this procedure should not be used to simply document the existence of a condition in order to enhance the medical record.
Photographs for the purpose of documentation for medical legal purposes or preauthorization (e.g., gross trauma, amount of ptosis or redundant lid tissue for blepharoplasty) are not separately reportable or reimbursable.
Photography may be reported only once per session, even though multiple views may be taken.
In addition to the photograph(s), an interpretation and report specific to the photograph(s) must be contained in the patient's medical record and be available to the contractor upon request.
External ocular photography without accompanying patient identification and date permanently affixed to the photograph will be considered not to be reasonable or necessary and will be denied.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2026-09-03
- Last reviewed by the contractor
- 2026-08-14
- MCD version
- 25
- Derived from
- L31880
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the CGS Administrators, LLC hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34393 cover?
External ocular photography is a non-invasive procedure used to photo-document conditions of the external structures of the eye (e.g., eyelids, lashes, sclera, conjunctiva and cornea). External photography techniques may also be used to document conditions related to structures of the anterior segment of the eye. These would include the anterior chamber, iris, crystalline lens and filtration angle. External ocular… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34393 apply to?
CGS Administrators, LLC applies it to Medicare claims in KY, OH. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34393?
The companion billing and coding article A57068 lists 1,056 ICD-10-CM codes in 1 group that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34393?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.