G8397 HCPCS code: Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy
G8397 is the HCPCS Level II code for dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | M5D |
| Added | 2008-01-01 |
| Last action effective | 2008-01-01 |
What changed for G8397
- 2008-01-01: G8397 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G8397?
G8397 is the HCPCS Level II code for dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy. Short descriptor: "Dil macula/fundus exam/w doc".
Does Medicare cover G8397?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G83 codes
- G8395 — Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
- G8396 — Left ventricular ejection fraction (lvef) not performed or documented
- G8398 — Dilated macular or fundus exam not performed
- G8399 — Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under G8397
- Watch G8397 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8397
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.