H. R. 6639
IN THE HOUSE OF REPRESENTATIVES
July 27, 2018
Mr. Reed (for himself and Ms. Sewell of Alabama) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
To amend title XVIII of the Social Security Act to provide for coverage under the Medicare program of digital retinal imaging with remote interpretation.
This Act may be cited as the
Diabetic Vision Loss and Blindness Prevention Act of 2018.
Medicare coverage of digital retinal imaging with remote interpretation
Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
in subsection (s)(2)—
in subparagraph (FF), by striking
and at the end;
in subparagraph (GG), by adding
and at the end; and
by inserting after subparagraph (GG) the following new subparagraph:
digital retinal imaging with remote interpretation (as defined in subsection (jjj));
by adding at the end the following new subsection:
Digital Retinal Imaging with Remote Interpretation
The term digital retinal imaging with remote interpretation means an exam for the purpose of early detection or assessment of diabetic retinopathy that—
is provided not more frequently than on an annual basis to an individual who has been diagnosed with diabetes and who—
does not have prior known diabetic retinopathy; or
is not known to have worse than mild non-proliferative diabetic retinopathy (ETDRS level 35);
is provided by or under the supervision of a primary care practitioner (as defined in section 1833(x)) or board-certified endocrinologist;
utilizes a retinal camera with optical resolution compliant with the International Organization for Standardization ISO 10940 to take digital images of structures behind the lens of the eye, such as the retina, choroid and optic nerve; and
involves the electronic transmission of such images for evaluation for diabetic retinopathy and other diseases of the eye by a board-certified, State-licensed ophthalmologist.
Notwithstanding section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m))—
payment shall be made pursuant to the amendments made by subsection (a) for digital retinal imaging with remote interpretation under CPT code 92250; and
the Secretary of Health and Human Services shall establish a national minimum payment amount for CPT code 92250 and any successor to such codes that is not less than the reimbursement rate in effect for such code (or predecessor code) on December 31, 2017.