Question 1

What is HCPCS code G8397?

Accepted Answer

HCPCS code G8397 is "Dil macula/fundus exam/w doc". Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy

Question 2

What category is G8397 in?

Accepted Answer

G8397 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8397?

Accepted Answer

Use G8397 when billing for dil macula/fundus exam/w doc. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G8397 covered by Medicare?

Accepted Answer

Coverage for G8397 (Dil macula/fundus exam/w doc) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G8397?

Accepted Answer

Documentation for G8397 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).