Cost Analysis of Teleophthalmology Screening for Diabetic Retinopathy Using Teleophthalmology Billing Codes

Area of Science:

• Ophthalmology
• Health Services Research
• Telemedicine

Background:

• Diabetic retinopathy (DR) screening is crucial for preventing vision loss.
• Teleophthalmology offers a scalable solution for DR screening.
• Evaluating the financial viability of teleophthalmology is essential for widespread adoption.

Purpose of the Study:

• To assess the financial sustainability of teleophthalmology screening for diabetic retinopathy (DR).
• To determine the impact of telehealth billing codes on the economic feasibility of DR screening programs.

Main Methods:

• Retrospective review of medical records and billing data at UC Davis Health System.
• Analysis of patients undergoing teleophthalmology DR screening using CPT codes 92227 or 92228.
• Evaluation of screening rates, costs, payments, incentive bonuses, referral revenue, and avoided clinic visits.

Main Results:

• DR screening rates increased from 49% to 63% (P < .0001) in a 12-month period.
• Average payment per patient was $19.86 against an estimated cost of $41.02.
• Projected per-patient revenue from bonuses ($43.06) and referrals ($39.38) exceeded costs.
• Elimination of 178 clinic visits yielded an estimated cost saving of $42.53 per patient.

Conclusions:

• Teleophthalmology DR screening can be financially sustainable.
• Sustainability is contingent upon effective telehealth billing, healthcare incentive bonuses, patient referrals, and recognition of cost savings from reduced in-person visits.