G8397 HCPCS Level II 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 code for “Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
G8397Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy
Short description: Dil macula/fundus exam/w doc
HCPCS · United States
Medicare details
The indicators CMS publishes with G8397 in its October 2026 file. They describe Medicare’s handling, not another payer’s.
- Medicare coverage
- Carrier judgment
- Medicare pricing
- Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)
- Type of service
- Medical care
- BETOS category
- Specialist - other
- Added
- Jan 1, 2008
Where G8397 sits
- 1G codesProcedures and professional services
- 2Active code G8397Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy
Source and release
- Data release
- HCPCS Level II · October 2026
- Effective date
- Oct 1, 2026
- Publisher
- CMS
This page is built from the HCPCS Level II catalog that Vero Codes reads when it suggests codes: Centers for Medicare & Medicaid Services’s October 2026 release, imported from the publisher’s file and checked against it. The description, notes and structured data come from the same record.
Frequently asked questions
What does HCPCS code G8397 mean?
G8397 is the HCPCS code for “Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover G8397?
CMS lists G8397’s Medicare coverage as “Carrier judgment” and its pricing as “Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)”. Coverage and payment still depend on the patient, the setting, the documentation and the payer.
Which HCPCS Level II release does this page use?
It uses CMS’s October 2026 release, in effect from Oct 1, 2026 to Dec 31, 2026. It is a reference: confirm the code against the current list and the payer’s rules before you submit it.
Codes beside G8397
All G codesG6058Drug confirmation, each procedureG8126Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phaseG8127Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phaseG8128Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measureG8395Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic functionG8396Left ventricular ejection fraction (lvef) not performed or documentedG8398Dilated macular or fundus exam not performedG8399Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performedG8400Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not givenG8401Clinician documented that patient was not an eligible candidate for screeningG8404Lower extremity neurological exam performed and documentedG8405Lower extremity neurological exam not performed