Medicare Reimbursement for Indocyanine-Green Angiography

Medicare covers fluorescein and/or ICG angiography when medically necessary.  FA allows the clinician to evaluate a wide variety of retinal diseases, such as proliferative diabetic retinopathy, macular edema, vascular occlusive disease, age related macular degeneration, and ocular tumors, as well as other retinal pathology.  ICG is performed to assess diseases of the choroid and subretinal anatomy (e.g., SRNVM, serous or hemorrhagic detachment of the RPE, and subretinal hemorrhage).  Covered diagnoses for ICG angiography may over-lap with, but are not the same as, those for fluorescein angiography.

This FAQ addresses the following:

  1. What are fluorescein and indocyanine-green angiography (FA and ICG)?
  2. What are the indications for these tests?
  3. Does Medicare cover FA and ICG?
  4. What documentation is required in the medical record to support these claims?
  5. Is the physician’s presence required during testing?
  6. What CPT codes should we use to describe these tests?
  7. What does Medicare allow for these tests?
  8. Are there restrictions on other codes that may be billed the same day?
  9. If coverage is unlikely or uncertain, how should we proceed?

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