Department of Ophthalmology & Vision Science, University of California, Davis Eye Center, Sacramento, California, USA.
Division of Biostatistics, Department of Public Health Sciences, Clinical and Translational Science Center, University of California, Davis, Sacramento, California, USA.
Telemed J E Health. 2023 Jan;29(1):81-86. doi: 10.1089/tmj.2022.0048. Epub 2022 May 24.
Lower insurance reimbursements have limited the financial sustainability of remote eye screening programs. Greater utilization and insurance coverage for teleophthalmology screening during the coronavirus disease 2019 (COVID-19) pandemic in 2020 may enhance awareness and expand remote retinal imaging services. This retrospective cross-sectional study evaluates utilization and insurance coverage for remote retinal imaging in the United States in 2020. We analyzed teleretinal imaging utilization and insurance payments from January 1 to December 31, 2020, using the Optum Labs Data Warehouse, a comprehensive national database of deidentified administrative claims for commercial and Medicare Advantage enrollees in the United States. We evaluated frequency of claims and insurance payment for services using the Current Procedural Terminology codes 92227 and 92228 for remote eye imaging by any provider, and 92250 for fundus photography by non-eye care providers. The use of remote retinal imaging in the United States declined rapidly during the initial COVID-19 lockdown from 3,627 claims in February 2020 to 1,414 claims in April 2020, but returned to 3,133 claims by December 2020, similar to mean prepandemic levels in 2019 (2,841 ± 174.8 claims). The proportion of insurance payments for remote imaging increased temporarily from 47.4% in February to 56.7% in April, and then returned to 45.9% in December of 2020. Utilization of remote retinal imaging declined steeply, while the insurance coverage increased during the initial COVID-19 lockdown in 2020, but returned to prepandemic levels by end of the year. Changes in utilization and relaxed restrictions on insurance reimbursements for teleophthalmology during the COVID-19 pandemic were not sustained.
较低的保险报销限制了远程眼科筛查项目的财务可持续性。2020 年冠状病毒病（COVID-19）大流行期间，远程眼科筛查的利用率和保险覆盖范围增加，可能会提高认识并扩大远程视网膜成像服务。本回顾性横断面研究评估了 2020 年美国远程视网膜成像的利用率和保险覆盖范围。我们使用 Optum Labs Data Warehouse 分析了 2020 年 1 月 1 日至 12 月 31 日的远程视网膜成像利用情况和保险支付情况，这是一个全面的美国商业和医疗保险优势参保者匿名行政索赔国家数据库。我们使用当前程序术语 (CPT) 代码 92227 和 92228 评估了任何提供者进行远程眼部成像的服务频率和保险支付情况，以及非眼保健提供者进行眼底照相的 92250 代码。在美国，COVID-19 封锁初期，远程视网膜成像的使用迅速下降，从 2020 年 2 月的 3627 项索赔下降到 4 月的 1414 项索赔，但到 2020 年 12 月恢复到 3133 项索赔，与 2019 年大流行前的平均水平相似（2841 ± 174.8 项索赔）。远程成像保险支付的比例暂时从 2 月的 47.4%增加到 4 月的 56.7%，然后在 2020 年 12 月又恢复到 45.9%。在 2020 年 COVID-19 封锁初期，远程视网膜成像的利用率急剧下降，而保险覆盖范围增加，但到年底恢复到大流行前水平。COVID-19 大流行期间，远程眼科学的利用率和保险报销限制放宽的变化并未持续。
